According to a study published in the New England Journal of Medicine Tuesday, researchers have concluded that the death toll in Puerto Rico from Hurricane Maria is more than 70 times the official count of 64 casualties, adding a lowball figure of at least 4,645 unrecorded deaths.
Per the study, it is especially challenging to tally death tolls after disasters like Hurricane Maria when infrastructure and health resources have fallen apart. The CDC reportedly classifies deaths as attributable to the storm 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.”
The process is made even more difficult in Puerto Rico because all disaster-related deaths must be verified by the Institute of Forensic Sciences, which entails either transporting all the bodies to San Juan or waiting for a medical examiner to travel out and check the corpse.
The survey found that interrupted medical care was the most prominent cause of death in the months after the storm, and that there was a high correlation between remoteness and loss of health services and electricity.
The authors of the study conclude that, based on their research, there are probably about 5,000 dead Puerto Ricans who have gone thus far uncounted.