New study places Hurricane Maria death toll at more than 4,600


The number of people killed in Puerto Rico amid Hurricane Maria is at least 70 times higher than the official government death toll, according to a study published Tuesday in the New England Journal of Medicine.

Researchers in the United States and Puerto Rico estimated more than 4,645 people were killed as a result of the storm, rather than the 64 people included in the official casualty count.

Authors of the study, titled “Mortality in Puerto Rico after Hurricane Maria,” noted their figure is “likely to be conservative,” saying the total could actually be in excess of 5,000.

“Our results indicate that the official count of 64 is a substantial underestimate of the true burden of mortality after Hurricane Maria,” the authors wrote.

Scientists with the Harvard T.H. Chan School of Public Health and Beth Israel Deaconess Medical Center randomly surveyed 3,299 households across Puerto Rico in early 2018, asking them “about displacement, infrastructure loss, and cause of death” between September 20 and December 31, 2017.

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Hurricane Maria destroyed village's only bridge to the outside world
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Hurricane Maria destroyed village's only bridge to the outside world
Ana Maria Jimenez, 89, lays on a bed after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY.
Dariana Baez, holds her one-month-old niece Amalia Garcia at her house after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017 REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A local resident carries a gasoline can as he crosses a river using a cable after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Local residents try to fix a truck after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
An America flag is seen after Hurricane Maria hit San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A boy looks at his neighbourhood after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A damaged house is seen after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Ismael Rivera stands at his damaged house after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A local resident carries a box of food as he walks along the side of a river after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Carmen Rodrigues stands by her bedridden mother, Rosa Maria Torres, 95, after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. The family are trying to get Torres airlifted out of the town. "If they don't move her out of here, she's going to die," said Carmen Santos, Torres' granddaughter. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Ismael Rivera stands at his damaged house after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Ramon Sostre, stands in front of his damaged house after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Haydee Mestre looks inside her refrigerator after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Local residents cross a river using a cable after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A general view of San Lorenzo after Hurricane Maria destroyed the town's bridge in Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A local resident takes a bath in a river after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
A local resident washes her hair at a pond after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Local residents stand by a bridge which was destroyed by Hurricane Maria in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Local residents walk along a road after Hurricane Maria destroyed the town's bridge and the surrounding areas, in San Lorenzo, Morovis, Puerto Rico, October 5, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES.
Ruth Santiago refreshes herself with water from a pipe after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY.
Local residents walk in a river after Hurricane Maria destroyed the town's bridge in San Lorenzo, Morovis, Puerto Rico, October 4, 2017. REUTERS/Alvin Baez SEARCH "BAEZ LORENZO" FOR THIS STORY. SEARCH "WIDER IMAGE" FOR ALL STORIES. TPX IMAGES OF THE DAY.
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Researchers noted that the Centers for Disease Control and Prevention allows for deaths to be “directly attributed to a tropical cyclone if they are caused by forces related to the event, such as flying debris, or if they are caused by unsafe or unhealthy conditions resulting in injury, illness or loss of necessary medical services.”

Hurricane Maria barreled into Puerto Rico as a Category-4 storm in September with winds of up to 155 miles per hour and intense rainfall, prompting flooding in the United States territory. More than eight months later, and the island’s recovery efforts — marred by a lack of water, electricity and general services — are ongoing.

Calculating the total number of dead in wake of a natural disaster can be difficult, the researchers said, citing a logistically challenging method for certifying death in San Juan. Every disaster-related death must be confirmed by the Forensic Sciences Institute, which requires that bodies be transported to San Juan or that a medical examiner travel to the municipality to verify the death.

The official death estimate has repeatedly been questioned by locals and experts, many of them blasting officials for their lack of transparency. It prompted the Puerto Rican government to commission and external review of the death registry data.

“As the United States prepares for its next hurricane season, it will be critical to review how disaster-related deaths will be counted, in order to mobilize and appropriate response operation and account for the fate of those affected,” the authors wrote.

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