Hurricane Florence’s battering of the southern United States has brought natural disasters and their devastating impacts back into the daily news cycle.
The Atlantic hurricane season is in full swing and while earlier assessments predicted a normal year compared to 2017’s monstrous season, 2018 is now poised to potentially set records for the number of named storms occurring simultaneously.
Layered on top of updates on Florence’s strength and path in recent days, as well as warnings to citizens about how to protect themselves, was an ongoing tirade from U.S. President Donald Trump disputing the death toll of last year’s Hurricane María in Puerto Rico.
Trump’s gale of tweets was unleashed when a new study from the Milken Institute School of Public Health of George Washington University estimated a revised death toll of almost 3,000 due to the hurricane.
3000 people did not die in the two hurricanes that hit Puerto Rico. When I left the Island, AFTER the storm had hit, they had anywhere from 6 to 18 deaths. As time went by it did not go up by much. Then, a long time later, they started to report really large numbers, like 3000…
Trump’s self-serving objections aside, this is not the first time Hurricane María’s death toll had been revised. The numbers have been adjusted several times, with estimates varying from a Harvard study that pegged it between 800 to 8,500 dead to the government of Puerto Rico’s confirmation in early August that 1,427 people died as a result of María’s fury.
But more importantly, Trump’s display of self-serving, defensive narcissism as he disputed María’s death toll has demonstrated in real time what many observers and students of disasters and the politics that surround them have long known: Disaster death tolls are notoriously difficult to determine accurately.
That’s despite our best efforts, and amid obvious attempts to use these estimates for political purposes.
What’s in a Number?
As scholars and practitioners in the governance area of disasters have made clear, there are limitations to the accuracy of estimates for a variety of reasons.
These include the unique conditions of each disaster as it unfolds, its immediate aftermath and disputes about who gets counted and who doesn’t.
As we have seen with the evolution of Hurricane María’s death toll, the numbers are subject to change and revision. In the case of María, the number has gone from the 16 deaths Trump cited when he visited the island and tossed half as many paper towel rolls into a crowd to the estimates of 3,000 we see the president angrily disputing today.
Because air-tight accuracy can be difficult when estimating disaster death tolls, it’s unsurprising these numbers are not only contentious but are also leveraged politically. Death tolls, along with other estimates of a storm’s strength, size and impact, (such as the Saffir-Simpson Scale that rates hurricanes by category), as well as damages estimated in total economic loss or insured losses, can all be used for political purposes.
Playing Politics With Perception
As I have written previously, disasters are immensely powerful and costly events that spawn a variety of responses and strategies.
While novel financing mechanisms and insurance strategies are certainly one way to address them, another is to manage the public’s perceptions regarding a particular natural disaster.
Political strategies aimed at shifting public perceptions are obviously nothing new, but they’re becoming even more important given the effects of climate change and increasingly intense weather systems. Trump’s howls of outrage over Hurricane María’s estimated death toll are likely aimed at changing public perceptions about the scope of the disaster, but it’s important to understand that he’s is hardly an innovator in this area.
Indeed, studies have shown that even the declarations of states of emergency within the U.S. are subject to political considerations. Researchers have demonstrated that FEMA disaster payments in different states are dependent on political considerations due to upcoming elections and races important to the president and his party.
Mutter says the government of Taiwan, on the other hand, chose to downplay the number of dead in the aftermath of the typhoon. This was due to a desire to be viewed as in control as well as more developed, as higher death toll numbers would negatively impact public perceptions of Taiwan.
What Florence and the inevitable storms to follow should underscore is that it’s important to remain critical of the narratives that are presented in the aftermath of these events. Politicians have many reasons to both underestimate and overestimate death tolls in the aftermath of natural disasters.
While we should continuously strive for the most accurate assessments of the impacts of these events, politics will continue to play an important role in which figures receive primacy and why.
PERU: Peru’s Fuerza Popular, known as fujimoristas,approved two of President Martín Vizcarra’s reforms for the legislative body. Vizcarra proposed the reinstatement of the Senate and a term limit for congressmen. Both motions have been approved by the party led by Keiko Fujimori, daughter of former president Alberto Fujimori.
Miguel Torres, a Fuerza Popular congressman, stated that the party is committed to addressing the lack of trust around the country’s politics and that the party will vote as a block in favor of Vizcarra’s proposals. If passed before October 4, the president’s four reforms for the legislative and judicial powers will become subject to a national referendum on December 9, 2018.
HEADLINES FROM THE WESTERN HEMISPHERE
MEXICO: After Mexican authorities were forced to move a refrigerated truck storing dozens of corpses, the governor of Jalisco fired the director of the state morgue for his “indolence and negligence” for the so-called mobile morgue. Former director Luis Octavio Cotero said that he told prosecutors about the dire situation of the increasing wave of bodies as a result of the ongoing drug war two years ago.
MEXICO: President-elect Andrés Manuel López Obrador claimed that Mexico is bankrupt during an event in Tepic, Nayarit. He said that his administration will not be able to meet all demands, but also assured to fulfill everything promised during his campaign. Emilio Azcárraga Jean, Executive Chairman of Televisa, ensured that there is confidence in the country’s economy and said that his company will support the new administration’s development projects.
UNITED STATES: Chrystia Freeland, Canadian Foreign Minister, arrived in Washington yesterday as Canada and the U.S. are set to resume talks on NAFTA today. Few days remain for the two nations to come to an agreement before September 30. Said due date was agreed upon to allow time for signing the new NAFTA deal before Mexico’s new administration takes office. The U.S. and Mexico already came to an agreement at the end of August.
JAMAICA: The Jamaican government imposed a ban on the importation, manufacture, distribution and, use of materials used in single-use plastics. Gradually starting in 2019, the country won’t allow single-use plastic carrier/shopping bags, styrofoam or plastic drinking straws. The ban aims to progressively reduce the use of plastics in the country.
PUERTO RICO: Ricardo Rosselló, the governor of Puerto Rico, presented two lawsuits against insurance companies that haven’t solved between 16,000 and 17,000 claims after hurricane María struck a year ago. The lawsuits seek to prevent the claims from expiring and to obtain $2.6 billion in damages.
GUATEMALA: Human rights associations filed a lawsuit against President Jimmy Morales for violating the Constitutional Court’s order to allow Iván Velásquez, U.N.-backed anti-corruption commissioner, to return to the country and continue his inquiries. Diana Ochoa, one of the five court judges, stated that their ruling annuls President Morales’ previous orders. María Consuelo Porras, General Attorney, stated that her office will continue to work with the Commission Against Impunity and that Morales —who has been linked to several cases of corruption— must respect the law.
HONDURAS: The Anti-corruption Council of Honduras uncovered five new cases of corruption that involve former First Lady, Rosa Elena Bonilla, as well as public officials from the Ministries of Health, Public Infrastructure and Energy. The investigation revealed that around $8 million dollars (more than $194 million lempiras) from public resources were illegally transferred to a network of companies linked to the families of the politicians. More than 70 new lines of investigation were opened regarding these new cases; between 12 and 15 have been judicially processed.
VENEZUELA: President Nicolás Maduro announced a series of 28 bilateral agreements between Venezuela and China. Already economic partners, China agreed to invest $5 billion more; Maduro said that this investment allows for Venezuela to double its oil exports to China. As part of the agreement, Venezuela agreed to cede 9.9 percent of its shares in SINOVESA, a joint-venture oil firm, resulting in a Chinese oil company owning 49 percent stake.
BRAZIL: Fernando Haddad, the presidential candidate who substituted Luiz Inácio Lula da Silva for the Workers’ Party, stated that if elected he would not grant a pardon to the former president. Lula currently serves a 12-year sentence for corruption convictions. He served as the Party’s official candidate until last week.
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Cubans are debating a constitutional reform that, among other legal changes, would open the door to gay marriage. It would also prohibit discrimination against people based on sex, gender, sexual orientation and gender identity in the communist nation.
The proposed new Constitution, drafted by a special commission within Cuba’s National Assembly, was unveiled in July. If the National Assembly and President Miguel Díaz-Canel approve the document after a February 24, 2019 public referendum, marriage would be defined as a “union between two people.”
Cuba’s 1976 Constitution, known as the Carta Magna, defines marriage as a union between a man and a woman. And it does not fully protect private enterprise, freedom of association or allows for same-sex marriage—despite growing social acceptance and political tolerance for such rights.
Emigrés who retain Cuban nationality have been invited to participate in Cuba’s public debate on the constitutional reform —though not to vote on it— via a digital forum run by the Foreign Ministry. This is a level of citizen outreach that’s “unprecedented” in Cuba, says Ernesto Soberón, the ministry’s director of consular affairs and Cubans residing overseas.
President Raúl Castro, who took over for his ailing older brother Fidel in 2006, began to open Cuba’s economy to foreign investment and normalized diplomatic relations with the United States, which has maintained its economic embargo on the Communist island since 1962.
Castro stepped down in April 2018, handing power over to the much younger Díaz-Canel.
Cuba has moderately amended its Carta Magna just three times. A 1978 constitutional reform created an official channel for youth political participation, for example, while that of 1992 liberalized elements of Cuba’s socialist economic model to revitalize Cuba’s economy.
Beyond legalizing gay marriage, the new Constitution would protect private property, limit the presidential term to five years and introduce the role of prime minister.
Intense debate has surrounded the possibility of marriage equality in Cuba, and not just within the government’s official public meetings. Cubans are also discussing and debating gay marriage with neighbors and friends, in the streets and online—a departure from Cuba’s traditionally more top-down style of government.
A lack of opinion polling makes it difficult to measure Cuban public support for gay marriage. But acceptance of homosexuality, both within the government and in civil society, has grown appreciably.
During the 1960s and 1970s, homosexuality was considered incompatible with Cuba’s model of the revolutionary man: atheist, heterosexual and anti-bourgeoisie. Gay people, active Christians and others who defied these ideals were sent to military work camps to “strengthen” their revolutionary character.
Today, the Cuban government appears to accept homosexuality as part of socialist society. In 2008, the National Assembly approved a law allowing sexual reassignment surgery.
La Habana holds annual marches against homophobia and transphobia, and cities across the island celebrate the Gay Pride parade.
The Church Emerges as an Opposition Force
But legacies of intolerance remain.
The Assembly of God Pentecostal Church, the Evangelical League and the Methodist Church of Cuba, among other Christian churches, have issued a joint statement opposing gay marriage.
Their public letter, published on June 8, argues that such “gender ideology” has “nothing whatsoever to do with our culture, our independence struggles nor with the historic leaders of the Revolution.”
Cuba is a secular country where political ideology has historically trumped religion. Religious opposition to a government proposal is rare.
It is even more unusual for the church to attempt to mobilize the Cuban public, as some Christian leaders are trying to do now.
According to the Cuban magazine La Jiribilla, preachers on the streets have been handing out fliers saying gay marriage defies God’s “original design” for the family.
LGBTQ Activists Answer
Gay rights groups and feminists are responding with a creative show of force.
Clandestina, Cuba’s first online store, and the tattoo studio La Marca are spearheading a campaign called “Cuban design,” celebrating a “very original family”—phrasing that rebuts Christian claims about God’s design.
“More than anything, this is an issue of free expression,” Roberto Ramos Mori, of La Marca, said in an email. “The way to push back against hate is calmly, with intelligence—and, of course, humor.”
Cubans with internet access use the hashtag #mifamiliaesoriginal to signal their support for LGBTQ rights on social media.
The church’s powerful opposition to marriage equality reflects a strategy commonly deployed across Latin America, says the Cuban feminist Ailynn Torres Santana.
Catholic and evangelical groups in Ecuador used similar language, for example, to oppose a 2017 law allowing citizens to choose their own gender identifier, she says. In response to the legislation —which recognized gender as “a binary that is socially and culturally created, patriarchal and heteronormative”— churches called for “citizens to live in harmony with nature.”
Similar scenes played out when both Colombia and Brazil advanced LGBTQ rights, with Christian groups dismissing any attempt to change traditional gender roles as the “result” of what they pejoratively call “gender ideology.”
What’s Next for Cuba
Gay marriage is not the only battlefield for Cuba’s newly empowered churches.
Abortion, illegal in most of Latin America, has been a woman’s right in Cuba since 1965. Traditionally, not even Cuba’s Catholic church publicly opposed it.
Joaquin “El Chapo” Guzman is renowned around the world as the now-imprisoned leader of Mexico’s Sinaloa Cartel, described by the U.S. Justice Department as one of the most “prolific, violent and powerful” drug cartels ever.
He’s perhaps the largest-looming figure in Mexico’s drug war, which is estimated to have caused the deaths of over 100,000 —mostly innocent— people.
El Chapo was arrested in 2014 after evading law enforcement for over a decade, and it wasn’t because of a slip-up. It was because two of his top men decided to turn on him.
Pedro and Junior Flores are twin brothers from Little Village, Chicago—a predominantly Mexican neighborhood. At just 22-years-old, they became key figures in the international drug trafficking world.
They met El Chapo in Mexico in 2005 after they fled a U.S. drug indictment. Shortly afterwards, they were running a North American drug ring worth nearly $2 billion. The brothers were living luxurious lives in Mexican mansions with their wives and children.
But after a bloody cartel war broke out, the Flores brothers began to fear for their lives, and the lives of their families. They fled, returning to the U.S. to seek the help of law enforcement as a way to get themselves and their families out of Mexico safely. In order to get that help, they agreed to become informants.
Pedro and Junior Flores are currently serving a 14-year reduced federal sentence and are set to be the key witnesses in El Chapo’s New York trial, set to begin in November.
Behind the sensational capture and trial is a family. Mia and Olivia Flores, the wives of the brothers, recently released a book about what it’s like to be married to two of the worlds biggest drug dealers—and to have a hit out on your family from one of the most powerful cartel leaders in the world. In this segment, they talk with Latino USA about their book Cartel Wives.
Featured collage includes images from Yuri Cortez/AFP/Getty Images and Ronaldo Schemidt/AFP/Getty Images, U.S. Marshals Service, and a book cover courtesy of Hachette Book Group.
ARGENTINA: Former President Cristina Kirchner was charged yesterday in a corruption scandal in which she is accused of heading an illicit organization involved in a bribery scheme. According to the indictment, Kirchner collected bribes from construction companies in exchange for public works contracts. The corruption scheme began with Kirchner’s former husband, Néstor Kirchner (who died in 2010) according to the indictment. After his death, Cristina Kirchner took the helm of the organization.
The Argentine newspaper La Nación uncovered the scandal in August when it published notebooks kept by a chauffeur of an official in the Kirchner administration. The notebooks contained damning details, such as a record of at least 87 times when the illicit organization delivered bags of cash to Kirchner’s private residence in Buenos Aires.
Kirchner, who is currently serving in the Senate, is not likely to be arrested due to the immunity bestowed on senators. She could, however, be prosecuted.
HEADLINES FROM THE WESTERN HEMISPHERE
MEXICO: Saturated by the number of murders resulting from the ongoing war against drugs, Jalisco state authorities resorted to a “mobile morgue” —a refrigerated semi-trailer truck— to store about 150 bodies. The truck has been moving between towns. After residents in the outskirts of Guadalajara city complained about the powerful stench, the state was moved to a facility near Jalisco state prosecutor’s office. The state’s General Secretary, Roberto López, told local media that a new facility that can hold 700 bodies is underway.
MEXICO & UNITED STATES: Federal government lawyers have stated that a 14-year-old leak in the Gulf of Mexico is causing more damage than they had previously stated, and that could it could get worse. A court filing from September 14 published that 10,000 to 30,000 gallons (37,000 to 113,000 liters) are leaking daily into the ocean from multiple platforms and wells that capsized during hurricane Ivan in 2004. The case involving the U.S. government and Taylor Energy Co. continues, as leak estimates reported in 2011 and 2015 were significantly smaller than was later revealed.
UNITED STATES: After a week of erroneous statements from Washington, fact-checkers confirmed that there are no advances or continuous construction of the border wall. The additional $1.6 billion requested by the Trump administration to add 65 miles along the Rio Grande Valley has not been given.
CUBA: Miguel Díaz-Canel gave his first interview since becoming Cuba’s president this past April. He told Venezuela’s outlet Telesur on Sunday the U.S.’s economic blockade represents “the foremost obstacle for the development of the country,” and denied that the Cuban government caused the mysterious health problems of about two dozen U.S. diplomats. Diaz-Canel also spoke about efforts to update his country’s constitution in a public referendum in February 2019. Among the updates is the recognition of same-sex marriage.
UNITED STATES & PUERTO RICO: Fact-checkers confirmed that a study commissioned by Governor Ricardo Rosselló associated more than 2,975 deaths to Hurricane Maria in the six months after the hurricane hit. This was after President Donald Trump tweeted, “3000 people did not die in the two hurricanes that hit Puerto Rico.”
GUATEMALA: Defying a court ruling, government officials have refused to let Iván Velásquez, the leader of an anti-corruption commission, re-enter the country. On Sunday, the Constitutional Court decided unanimously that President Jimmy Morales’ administration should allow the U.N. investigator to return. The commission has resulted in the prosecution of former presidents and other top officials, and is waiting on action from lawmakers to pursue an investigation of Morales.
NICARAGUA: Two protestors were arrested during a march Sunday in Nicaragua’s capital city, Managua. Javier Espinosa and Norwin Gutiérrez were among thousands of demonstrators who continue to demand the release of more than 300 political prisoners and the resignation of President Daniel Ortega. No one was seriously injured in this latest march. Since April, hundreds have died in clashes between protestors, pro-government paramilitary groups, and police.
PERU: President Martín Vizcarra announced he will hold a special session with lawmakers Wednesday to debate his proposal on anti-corruption measures. If the opposition-leaning congress votes to block the measures, Vizcarra could dissolve Congress, which he has previously threatened of doing. If he does, Vizcarra would be the first Peruvian president to do so since former dictator Alberto Fujimori in 1992.
VENEZUELA: Politicians and organizations across Latin America are denouncing a comment made last week by Secretary General of the Organization of American States (OAS) Luis Almagro that military intervention should not be ruled out in Venezuela. Bolivian President Evo Morales is among the leaders who spoke out against Almagro, along with the Cuban embassy in Venezuela, the Bolivarian Alliance for the Peoples of Our America – People’s Trade Treaty and the Communist Party of Uruguay. Almagro’s comment comes after the New York Times revealed that U.S. officials met with a group of Venezuelans to discuss overthrowing President Nicolás Maduro.
BRAZIL: Brazilian authorities seized more than $16 million in cash and luxury watches from the delegation of Equatorial Guinea Vice President Teodorin Nguema Obiang, who is the son of the African country’s president. No one is allowed to enter Brazil with more than $2,400 in cash. The Equatorial Guinea embassy told Brazilian authorities that Obiang, who is known for his luxurious lifestyle, was in the country for medical reasons.
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Versión en español aquí. Interactive graphics here.
Four hundred and eighty seven stories of extreme and inhuman suffering, each one with its own name, prove that many of the deaths caused by Hurricane María could have been avoided, while revealing the causes that led to this historic rise in mortality in Puerto Rico.
The latter is evidenced by the only comprehensive record available of the deaths related to the hurricane, documented by a joint investigation of the Center for Investigative Journalism (CPI), Quartz (QZ) and Associated Press (AP). The existing list is that of the Government of Puerto Rico which still includes only 64 deaths.
Meanwhile, U.S. President Donald Trump —who has downplayed the magnitude of the catastrophe since the beginning and glorified his response level— said on Thursday that the estimate of deaths validated by the government of Puerto Rico and produced by George Washington University (GWU) is yet another fabrication from Democrats to make him look bad.
“3000 people did not die in the two hurricanes that hit Puerto Rico. When I left the Island, AFTER the storm had hit, they had anywhere from 6 to 18 deaths. As time went by it did not go up by much. Then, a long time later, they started to report really large numbers, like 3000…This was done by the Democrats in order to make me look as bad as possible when I was successfully raising Billions of Dollars to help rebuild Puerto Rico. If a person died for any reason, like old age, just add them onto the list. Bad politics. I love Puerto Rico!”, he tweeted.
For about four hours, President Trump visited Puerto Rico on October 3, almost two weeks after the storm. According to the mortality statistics of the Puerto Rico Demographic Registry, from September 6 to the time of Trump’s departure, 640 people had died in excess of the average number of deaths during that same period in the previous three years.
One year after Hurricane María, the risk of seeing this tragedy repeat itself is real as systemic failures in access to health services and infrastructure —which caused the majority of deaths— have not been corrected, according to experts interviewed, and also admitted by Puerto Rico Governor Ricardo Rosselló.
“How prepared are we for a hurricane such as María? Well, the truth is that if a hurricane of that nature comes, we will receive the same, a little less or a little bit more devastation. There is no doubt about that,” Gov. Rosselló said when asked by the CPI during a press conference in late August over deaths related to Hurricane María.
The debacle in the three months that followed the hurricane was of such magnitude that it changed the face of death in Puerto Rico, modifying the island’s demographics and main causes of death, yielded the investigation, which also included an analysis of the Demographic Registry’s mortality databases and thousands of death certificates obtained following a lawsuit filed by the CPI to obtain access to that information.
According to the data, the segment in which most deaths were recorded for the entire population, during the three months following the hurricane, was that of young adults of productive age, 30 to 44, with a percentage increase between 23% to 39%, compared to the average of the previous three years. This contrasts to the widely believed, government-backed perception that the elderly people and those with pre-existing medical conditions were the ones who mostly died. Deaths among people over age 70, although more in net numbers, as they usually are, increased between 8% to 10%.
Solidarity Some of Those Who Died (The Entire List Is Here)
Likewise, sepsis, which has never been among the 10 leading causes of death in Puerto Rico —according to the Centers for Disease Control & Prevention (CDC — was the eighth leading cause of death during that period.
Dozens of stories of victims’ relatives tell how people bedridden and with diseases not related to the hurricane, such as bedsores or even a cavity, ended up dying of sepsis due to the unsafe and unhealthy temperatures and conditions that prevailed in hospitals, as well as the lack of treatment.
Among them is Ramona González Muñoz, who died in her home of bedsores at age 59 after being denied treatment in three hospitals, according to her relatives. The woman, who was bedridden two years ago with a degenerative brain disease, developed bedsores following Hurricane María, when she could not turn on the air conditioning in her room due to lack of power. She was taken twice to hospitals in San Juan, but in both instances she was discharged without being treated because the institutions could not handle the amount of patients.
Desperate, her family tried on October 19 to have her admitted at the USNS Comfort —a U.S. Navy hospital ship brought to Puerto Rico to respond to the emergency— but they found a complicated admission process that required patients were referred through the leading public hospital in Puerto Rico, the Medical Center.
Ramona died the next day at the Ashford Presbyterian Hospital in San Juan.
Other causes of death that saw significant increases, from 20% to 45%, were pneumonitis due to solids and liquids, primary hypertension and kidney disease, pneumonia and influenza, and respiratory, Alzheimer’s and heart diseases. Suicides, which are grouped under a category called “other causes,” registered an increase of 43.9%.
Among young adults ages 30 to 44, the causes suggest accidents and heart attacks, according to a review of death certificates and the CPI-QZ-AP registry. A fifth of these deaths are still under investigation.
“These are deaths that could have been avoided,” said Dr. Cruz María Nazario, an epidemiologist and professor at the Medical Sciences Campus of the University of Puerto Rico. She is also one of the researchers of the GWU mortality study.
Dr. Irwin Redlener, director of the National Center for Disaster Preparedness at Columbia University in New York, agreed that the deaths could have been prevented with better preparedness and response to the emergency.
He argued that the response to the disaster by the Puerto Rico and U.S. governments was extremely unsuccessful, although in many cases there were pre-existing conditions that affect mortality and resilience, such as a high level of poverty, lack of access to health services in Puerto Rico and no adequate preparation to face the storm.
Nazario explained the increases in the sepsis and pneumonia & influenza categories are particularly interesting as they do not correspond to diseases or diagnoses that people had before the hurricane, but rather to circumstances that arose due to the total collapse of the health system of Puerto Rico and that, in essence, are preventable.
“These two diseases have served as sentinel death causes that we must continue using in future events because they give us a very quick idea that there is a problem that must be addressed urgently,” she said.
In the case of chronic diseases, such as respiratory and kidney diseases, Nazario emphasized that most patients live if they receive their medications and treatments, which ceased to occur for weeks and months after the storm, victims’ family members told the CPI-QZ-AP alliance.
In dozens of cases, victims’ relatives attribute the death to the lack of dialysis, insulin or oxygen. In total, 300 people in the sample died of chronic diseases, such as diabetes, cancer and Alzheimer’s.
That was the case of Orlando López Martínez, 48. He has received dialysis treatment since 2014 as a result of diabetes, which he developed at age 11. In the aftermath of María, he lost at least four treatments because the Atlantis center in Aguadilla —where he received dialysis treatment four and a half hours a day, three times a week— was shut down. When it reopened, it did so by rationing services because it lacked enough fuel and water, so López started receiving only two hours of dialysis in each session.
He died on October 10. The official cause of death listed on his death certificate was a heart attack caused by kidney disease. It says nothing about Hurricane María or the lack of adequate treatment.
“In those days after the hurricane, he looked pale and yellow, he looked really bad,” said Lady Diana Torres, the mother of Paola, the 10-year-old daughter López left behind.
Meanwhile Paola is trying to cope with the sudden death of her dad. She did not talk much about it until her school brought in a social worker to talk to children who had lost family members because of the storm.
“The social worker spoke with her and with others who had gone through the same thing. And then everyone talked to her and she cried so much,” her mother recalled, in tears.
The qualitative and detailed information provided by the victims’ relatives to the CPI, qz.com and AP —known as “verbal autopsies”— is of great importance, Nazario said. It is the only source of information that exists about the mechanisms that triggered the clinical causes of death documented by the Demographic Registry and that go to the heart of the relationship between the increase in deaths and the hurricane, as the case of López demonstrates.
Among them are the lack of oxygen, electricity and water in hospitals and treatment clinics such as those for dialysis and chemotherapy; problems with communications and emergency transportation; anxiety and depression; and all kinds of accidents linked to disaster management efforts and deficiencies of basic services such as lack of power in homes and traffic lights on the roads. In the CPI-QZ-AP registry, death reports due to accidents are twice the number of those registered among the general population.
Three weeks after Hurricane, Saúl Pabey Martínez, 27, died in Peñuelas trying to connect a friend’s home to the power grid. The plan was to climb on a pole and make the connection, but Martínez was electrocuted and fell.
“The people [who accompanied him] picked up the ladder and left him there,” said his mother, Doris Milagros Martínez. A policeman found the body.
A week later, Juan Gabriel Valentín Fuentes went to the house of his boss, Ramón Edwin Colón, to cut down a tree that María had knocked down in the patio. One of the branches fell on him and went through his heart.
“We tried to help him but we could not. A digger got him out,” Colón said. Valentín was 32 years old.
On November 5, Kenny Huertas, 30, suffered a fall while helping his neighbors clean up debris. He died that day as a result of the accident.
“That is very valuable because those are possibly the causes of death that the Demographic Registry will never record as related to the hurricane. The value of the sample is precisely in these stories that detail the circumstances that triggered or aggravated the health problem that ended in the clinical death, which is what shows up in the Registry,” said Nazario about the increase recorded in the sample of deaths from accidents.
The systemic failures that sparked the deaths respond to negligent acts by both the Puerto Rico and federal governments, as well as the hospital industry, which at the time of Maria’s landfall, did not meet the standards of planning and preparation to adequately deal with the disaster. All these factors are among the reasons for the high mortality.
In a self-assessment report issued in July 2018, the Federal Emergency Management Agency (FEMA) acknowledged there were failures in its response to Hurricane Maria in Puerto Rico such as inadequate preparation, supplies shortage and coordination problems, as well as assuming tasks that belong to the local government. FEMA Administrator Brock Long did not respond to a request for an interview made by AP.
Before the hurricane, the Puerto Rico government has said it only had emergency plans that were outdated and designed for Category-1 hurricanes, according to the GWU study. Former emergency management directors, however, say that plans for Category 5 hurricanes did exist and were not used. Despite multiple petitions, Puerto Rico’s State Bureau for Emergency & Disaster Management (NMEAD by its Spanish initials) has not provided a copy of the plan that existed by the time María made landfall, nor the revised plan it says it has ready.
Causes of Death
Six months before the hurricane, the commonwealth government consolidated all the emergency response agencies within the newly created Department of Public Security (DSP), led by Secretary Héctor Pesquera. It merged under a single leadership important dependencies that historically have had autonomy, such as the Puerto Rico Police, the Medical Emergency Corps, the Institute of Forensic Sciences (now the Bureau of Forensic Sciences), the State Agency for Emergency & Disaster Management (now NMEAD) and the Fire Department. Puerto Rico’s Health Department was not part of the merger, yet it was also subject to Pesquera’s command during the emergency. Former directors of NMEAD, such as Epifanio Jiménez and Ángel Crespo, have strongly criticized the change, saying that the move affected the government’s response capacity in the face of the crisis.
Nazario argued this was negligent from a public health point of view, changing everything at once without having an alternative plan. “That is the problem with the system failure. The problem was systemic, it is not that it failed here and there, it is that everything failed at once. Why? Because everything was overthrown and deconstructed at the same time,” she said.
NMEAD announced on September 1 that it has a new emergency operational plan ready, but refused to provide a copy of the document on the grounds that it is “confidential.” The emergency plans of all the states devastated by natural disasters during the past decade —Florida, Texas, New York, California and Louisiana— are all public and available on the Internet.
Pesquera, the Rosselló administration official in charge of the government’s failed response to the emergency and underestimation of deaths, said he was willing to sit down for an interview, but after a calendar conflict, he did not schedule for it.
“I have not seen the plan. I believe that if there is a plan, the first thing that must be done is to disclose it and, above all, to circle it in those agencies that can provide feedback and improve it or correct it. It is not to keep it in a drawer of Pesquera’s office and that he can say there is a plan,” said the epidemiologist.
The Department of Health also did not have a public health emergency response plan to tell health institutions and patients how to respond to a disaster and where to go. Waddy González, a FEMA official in charge of the health component in Puerto Rico, said in an interview that Health Secretary Rafael Rodríguez Mercado has prepared such a plan, but that it has not been made public to the hospital industry and citizens. Rodríguez Mercado refused to be interviewed for this story and did not respond to multiple requests to provide a copy of this plan.
The consequence of dismantling emergency response institutions and lacking adequate response plans was that, after the storm, local and federal agencies did not react with the agility and forcefulness needed to protect citizens, who died by the hundreds, usually for preventable causes.
Most of these deaths occurred in hospitals, which experienced an increase in mortality of 32.3% and were practically inoperative, without electric service, without generators or with deficient ones, and without fuel reserves to operate, according to several testimonies and visits made. The Department of Health, the agency that inspects hospitals and licenses on behalf the Centers for Medicare & Medicaid (CMS), acknowledged that it does not have the resources to timely perform this function and has refused to provide evidence of visits to the facilities after Hurricane Maria. CMS also failed to provide the documents despite multiple requests for this information.
“Maybe in the future we would need a policy that requires that in order to obtain a certification or license to operate [a hospital], you have to be able to mitigate a Category-5 hurricane. For example, you have to have generators, ready, with several days of supplies,” said Alexis Santos, a demographer from the Pennsylvania State University who has extensively analyzed death statistics after Hurricane María. He noted that the data serves to identify failures and create public policy that corrects them and prevents deaths during the next emergency.
Deaths by Age Group
Jaime Plá, executive president of the Puerto Rico Hospital Association, minimized the faults of these health facilities during an interview, as he attributed the increase in deaths to the idea that people with chronic conditions —desperate for the lack of power in their homes, nursing homes or dialysis clinics— practically “came to die in hospitals.” Although the evidence proves that, in effect, all the components of the health system failed, from pharmacies to Puerto Rico’s Medical Center, it also demonstrates fatal flaws in the operation of hospitals.
While he acknowledged that the mistakes made by the Puerto Rico government in preparing and responding to the emergency were enormous, Redlener placed the greatest weight of responsibility on the U.S. government, which having the resources to respond in time and with the strength needed to avoid deaths, failed to do so.
“The Puerto Rico institutions simply did not have the resources and experience that were needed,” he said.
Redlener added that the U.S. government was “negligent” in not sending to Puerto Rico the resources and aid that the scale of the disaster called for. He argued that although the U.S. Army has the ability to reestablish communications, establish temporary electrical systems, rebuild bridges and ensure medical transportation better than any other agency, “it was not activated and deployed on time or at the level that should have been done.”
“This was an inexcusable failure of the U.S. Army, to bring their A game to a major disaster affecting American citizens,” Redlener stressed.
He also recalled that the White House reacted to the hurricane as if it were a minor event and even on October 3, during his visit to Puerto Rico, President Trump congratulated himself on the federal government response.
“I do not think that President Trump cared much [about what happened in Puerto Rico]. I do not know how to put it another way. That was the attitude,” Redlener added.
The expert said that the low number of fatalities reported by the government of Puerto Rico also played a role in the slowness and low level of the federal response.
“The data [on deaths] is important and in many ways,” he said.
“Puerto Rico paid the price for this. If you start by not taking things seriously, nothing works properly,” he further noted.
Redlener added that, now in the recovery phase, he sees the same inconsistency between the real scale of the catastrophe and the resources that are being allocated for reconstruction, as well as the way in which Congress is setting budgetary priorities well below what is required. Congress has approved more than $140 billion in recovery funds for areas hit by natural disasters in 2017. To access them, Puerto Rico has to compete with other affected jurisdictions, including Texas, Florida and California. Federal funds that have been allocated directly to the island, about $16 billion, represent a fraction of what the Rosselló government says it needs. For example, according to his calculations, repairing Puerto Rico’s electricity system would cost $17 billion. So far, Puerto Rico has only secured $2 billion from the federal government for this.
The increase in mortality in Puerto Rico after Hurricane María and the denial of this reality by the government of Puerto Rico were first revealed by the CPI on September 28, 2017. Ever since that publication, the CPI, international media and academics have continued to investigate the situation, producing estimates of excess mortality that greatly exceeded the government’s official number of certified deaths. Death toll estimates range from 800 to 8,500 deaths, the range determined by a Harvard University study published in May, which sparked a massive protest by citizens, many of whom left empty shoes in front of the Capitol in San Juan in honor for their loved ones who died because of the hurricane.
Three weeks before María’s anniversary, the government of Puerto Rico finally adopted the 2,975 figure of the GWU study it commissioned as its “official estimate” of victims. However, this estimate, as well as the other excess mortality figures that have been published to date, are only mathematical computations that do not correspond to real victims of the disaster, do not list the names of the deceased nor talk about the reasons that led to the deaths.
In contrast, the CPI-QZ-AP alliance documented the stories of 487 people who died during the emergency, told by their families and corroborated with interviews, documents and data from the Puerto Rico Demographic Registry. This puts a face to the victims. The deaths listed in the registry verified by the three media outlets would be linked to the hurricane under CDC parameters. These include deaths due to the physical forces of the hurricane, such as landslides or floods; they also take into account those associated with the consequences of the storm, such as the lack of medical services, unhealthy conditions and stress.
During the press conference in which Gov. Rosselló announced the findings of the GWU study, he admitted that his administration failed in its response to the disaster caused by Hurricane María and assumed the responsibility for the “enormous” number of deaths. He also acknowledged that Puerto Rico is not ready to successfully face a hurricane of such magnitude, said that the electrical system is “equally or more vulnerable than it was before the storm,” and estimated that it will take years before being prepared for another event such as María.
Rosselló did not grant the interview requested by the CPI-QZ-AP alliance.
The joint research conducted by some 30 journalists and collaborators that are experts in health, demography and statistics, evaluated several sources of information: the databases of causes of death in Puerto Rico from 2014 to 2018 and 23,000 death certificates, obtained after a CPI lawsuit against the government. It also included a sample of 487 verified cases of deaths related to the hurricane for which relatives of the victims related —through an online form, in person or through telephone interviews— the circumstances in which their loved ones died.
It took Gov. Rosselló three months, at least a dozen investigative reports, two demographic analysis of excess mortality —one from the government itself through the Demographic Registry— and various public expressions of epidemiologists to admit that his mortality figure was wrong. Eight days after María’s landfall, the CPI had already published evidence pointing to hundreds of deaths and that the government’s death toll was wrong. The CPI has asked Gov. Rosselló for several interviews to discuss about the matter since October 2017, but they have not been granted.
The governor ordered on December 21 a recount and in-depth study over the deaths, first to Pesquera, the official who failed and called as false the reports on high mortality, and then to the Public Health School of GWU, which generated the aforementioned estimate of excess mortality on August 28. Gov. Rosselló’s request to these health professionals, however, did not include an analysis of the causes for such high mortality, so the study did not include this vital information. Being an estimate, GWU did not produce a new list of victims either.
When it comes to saving lives, disaster preparedness plans for the short, medium and long term and developed with the input and participation of the communities are key, said Dr. Jennifer Horney, director of the epidemiology program.at University of Delaware. She explained that local knowledge of which population needs oxygen or dialysis, for instance, is fundamental. Dialysis patients are the most vulnerable because they have a tight timeframe: losing an appointment results in serious health consequences, she said.
“Without a pre-disaster recovery plan communities just tend to be sort of doing a lot of things at once and not focusing on where the greatest needs are. There’s going to be a lot of pressure to do a lot of things very quickly. Trying to plan in the immediate aftermath of a disaster is really difficult,” Horney explained.
She further said that the type of care available to people with critical conditions will have a huge impact on their survival and future complications.
“Chronic conditions, which are manageable, can become deadly very quickly without proper care. For example, if a child with asthma can’t access their inhaler, that child’s life is in danger. The lack of appropriate services for these conditions manifest as very serious complications and can lead to death,” agreed Dr. Redlener of Columbia University.
Taking this into consideration, deaths in Puerto Rico were predictable, since pharmacies were closed, and the supply chain collapsed, he added.
“It’s a very dangerous situation,” Redlener stressed.
A year after María, this situation still lingers.
Dánica Coto, from the Associated Press, and andJeniffer Wiscovitch, from the Center of Investigative Journalism, collaborated in this story.
About the investigation
This is a database of people who died due to Hurricane Maria.
Over the last year, reporters from Quartz and Puerto Rico’s Center for Investigative Journalism (CPI) collected hundreds of stories from Puerto Ricans who say their relatives died because of Hurricane Maria but were overlooked by the government. With the Associated Press, names of the dead were matched against government death records released by the Puerto Rican government in response to a lawsuit by CPI. Together, we interviewed about 300 families of the dead and reviewed the records of nearly 200 others using the Centers For Disease Control and Prevention’s criteria for certifying disaster-related deaths.
Most of the deaths in the project’s database are considered indirect, meaning they were not caused by winds or flooding but rather made more likely because of factors like the lack of power, fresh water and medical supplies after the storm. The project did not interview the patients’ doctors and the death certificates themselves make no link to Maria. The Puerto Rican government acknowledges that hundreds or thousands of deaths should have been classified as storm-related but weren’t, due to doctors’ lack of training on how to correctly fill out death certificates. Participation in this survey was voluntary; therefore, the sample is not representative of Puerto Rico’s demography and was not used to extrapolate trends in causes of death and demographics.
The project analyzed mortality databases from the Demographic Registry of Puerto Rico from 2014 to 2017 to calculate changes in demographics and cause of death rates across the whole population, using ICD-10 standard grouping for 50 cause-of-death rankings.
More than 30 journalists from the AP, Quartz, and CPI participated in the project.
The interactive story and database was designed and built by Quartz visual journalist Youyou Zhou.
CPI: Omaya Sosa Pascual, Carla Minet, Laura Candelas, Jeniffer Wiscovitch, Laura Moscoso, Víctor Rodríguez, David Cordero. With help from Luis Trelles, Cindy Burgos, Mari Mari Narvaez, Edmy Ayala and Emmanuel Estrada.
Quartz: Ana Campoy, Youyou Zhou, Caitlin Hu, David Yanofsky. With help from Daniel Wolfe, Nikhil Sonnad, Feli Sanchez, Max de Haldevang.
AP: Michael Weissenstein, Ezequiel Abiu Lopez, Luis Alonso, Claudia Torrens, Ben Fox, Danica Coto, Maricarmen Rivera, Gisela Salomón. With help from Mark Thiessen, Rachel D’oro, Dan Joling.
Consulting by demographer Raúl Figueroa and public health experts Luis Emmanuel Rodríguez Reyes and Luis Alberto Aviles of the University of Puerto Rico.
Volunteer students from the Carlos Albizu University in San Juan, Interamerican University and University of Puerto Rico helped with data extraction and conducted many of the verification calls to victims’ relatives: Iliana Sepúlveda Montes, Iris de Oleo, Irmary Rodríguez Rivera, Kathyria Vega, Magda Rolón Velez, Neysha Burgos, Yomara Belardo, César Medina, Zahaira Cruz Aponte, Anayra Santiago and Steven Jiang
The art in the site is by Puerto Rican artist Antonio Martorell.
HONDURAS: Starting today, the alleged murderers of indigenous leader Berta Cáceres will stand trial in Tegucigalpa, in a case that seeks justice for one of the most notorious killings of environmental activists in Central America. In March 2016, Cáceres was shot dead in her house a week after opposing the construction of the Agua Zarca hydroelectric dam.
At least four of the eight men accused of participating in the shooting have been linked to Desarrollos Energéticos, S.A. (DESA), the company licensed in the development of the dam, and the Honduran Armed Forces. Previous investigations suggest Cáceres’ name appeared on a military hit list months before her murder.
Cáceres was a member of the Lenca people, the largest indigenous community in Honduras. She was also a prominent human rights activist and a 2015 Goldman Environmental Prize winner. The trial against her executioners is expected to conclude on October 19.
HEADLINES FROM THE WESTERN HEMISPHERE
MEXICO: On Saturday night, five gunmen disguised as mariachis at Mexico City’s iconic square, Garibaldi Plaza, killed five and wounded eight before fleeing on motorcycles. While investigators tried to pin down the attackers, festivities for Mexico’s Independence Day continued as planned and musicians proceeded to play. Security experts believe the ambush may be linked to a gang turf war.
MEXICO: Mexican president-elect, Andrés Manuel López Obrador, introduced his new head of security, Daniel Asaf, in an unconventional move to hire unarmed and untrained bodyguards. It was the first of many days that Daniel Asaf will be surveilling López Obrador’s nationwide tour. Asaf, a Lebanese-born restaurateur, will be in charge of 20 rotating civilian assistants who will help the president-elect engage with voters without being trampled. López Obrador rejected the use of 8,000 trained security guards traditionally hired to isolate the president from crowds.
UNITED STATES: Víctor Hugo Cuéllar-Silva, a Colombian drug trafficker who reports to Mexican kingpin Ángel Humberto Chávez-Gastelum, was indicted on federal drug trafficking charges in Los Angeles on Friday. Almost 50 people are being charged for shipping 7,700 pounds of cocaine into the U.S. Authorities uncovered the drug in speedboats, submarines, a private jet and in frozen orange juice cubes. Cuéllar-Silva pleaded not guilty and is being held in custody.
EL SALVADOR: El Salvador’s prosecutors requested to extradite former President Mauricio Funes on corruption charges last Friday. Funes, who served with the leftist FMLN party between 2009 and 2014, is accused of embezzlement and money laundering involving over $351 million. This comes after Funes’ predecessor, Antonio Saca, became the first Salvadoran president to be given prison time after pleading to similar charges.
COSTA RICA: Today marks the seventh day of general labor strikes in Costa Rica. Demonstrators took to the streets of San José and other cities to protest a fiscal bill proposed by newly-elected President Carlos Alvarado. The tax reform would convert the 13 percent sales tax to a “value-added tax,” affecting several products and services. Alvarado has called on the church and university officials to mediate in this conflict, but students and public sector employees have called for an indefinite strike.
COLOMBIA: A leader of one of FARC’s largest dissident groups was seriously injured Saturday when he was attacked by the Colombian army near the Ecuador border, President Iván Duque said. Walter Arizala, also known as “Guacho,” is one of the most sought-after rebel leaders. As the head of the Oliver Sinisterra Front, Arizala has been linked to car bombings, kidnappings, and the murder of several journalists in Colombia and Ecuador.
CHILE: Pope Francis expelled a Chilean priest accused of child sexual abuse Saturday. The priest, Cristián Precht, was a central figure in the fight against dictator Augusto Pinochet. In the 1970s, Precht tried to put an end to torture practices in the country. His expulsion is the latest development in a global sex abuse scandal that has rocked the Catholic Church.
ARGENTINA: Argentine authorities announced the seizure of $3 million worth in cameras, lenses, screens, microphones, and other film equipment stolen from Hollywood and New York after carrying out 10 raids on Thursday. This is the conclusion of a two-year operation called “Hollywood Stolen.” The thieves stole the equipment from Hollywood producers and rented it out on the black market in Argentina, according to the Federal Police.
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In June, Silvia Vásquez-Lavado summited the highest mountain in North America, a mountain in Alaska named Denali.
Denali was the final peak that Silvia needed to complete the “Seven Summits Challenge.” The challenge consists of climbing the highest peak on each of the seven continents, which includes, of course, the highest mountain in the world, Mount Everest. By completing the challenge, Vásquez-Lavado became the first Peruvian and first openly gay woman to do so.
As a survivor of sexual abuse, the mountaineer began her adventure in 2005 as a way to heal and find her own inner strength. Soon after, she created Courageous Girls, a non-profit that helps victims of sexual violence through mountaineering.
In this edition of “How I Made It,” Silvia shares what it feels like to stand on top of the tallest mountains in the world.
Jason Chang is the author of Chino: Anti-Chinese Racism in Mexico. In this segment, he sits down with host Maria Hinojosa to discuss the history of Chinese migration to Mexico, first in the 1800s and then again in the 1900s. Together, they unpack the parallels between the anti-Chinese rhetoric used in Mexico during that time period, and the current anti-immigrant rhetoric used by the U.S. administration today.
Featured image by Alfredo Estrella/AFP/Getty Images