George Washington University Hurricane María Mortality Study (2018)

Ascertainment of the Estimated Excess Mortality from Hurricane María in Puerto Rico
George Washington University Milken Institute School of Public Health
Commissioned by the Government of Puerto Rico
Published August 28, 2018

Executive Summary:
This study was commissioned by the Government of Puerto Rico to provide an independent, scientifically rigorous estimate of excess mortality resulting from Hurricane María, which struck Puerto Rico on September 20, 2017.

Key Finding: An estimated 2,975 excess deaths occurred in Puerto Rico from September 2017 through February 2018 as a result of Hurricane María — compared to the same period in previous years.

Methodology:
- The study used vital statistics mortality data from the Puerto Rico Demographic Registry
- Compared actual deaths to expected deaths based on historical patterns (2010-2017)
- Applied a statistical model that accounted for population displacement (emigration), seasonal patterns, and demographic characteristics
- The 95% confidence interval ranged from 2,658 to 3,290 excess deaths

Key Findings:

1. Official count vs. reality: The Puerto Rico government's official death toll at the time was 64 deaths. This study demonstrated that the actual excess mortality was approximately 46 times higher than the official count.

2. Risk factors: Excess mortality was significantly higher among:

   • Males
   • Persons aged 65 and older
   • Persons living in municipalities with high poverty rates
   • Persons living in remote, mountainous areas with limited infrastructure

3. Timeline: Excess mortality persisted for at least six months after the hurricane — demonstrating that deaths were not limited to the immediate storm but resulted from the prolonged failure of essential services (electricity, water, healthcare, transportation).

4. Causes: While direct cause of death was often recorded as natural causes (heart disease, diabetes, sepsis), the study found that the disruption of medical services, lack of electricity for medical equipment, contaminated water, and infrastructure collapse contributed to deaths that would not have occurred absent the hurricane.

5. Healthcare system collapse: The destruction of electrical infrastructure meant that hospitals operated on generators (when available), dialysis centers closed, refrigerated medications spoiled, and patients with chronic conditions could not access routine care.

Significance:
This study forced the Puerto Rico government to officially revise the death toll from 64 to 2,975 — acknowledging the catastrophic failure of the emergency response. The study also provided evidence for arguments that:
- The federal response was grossly inadequate
- Colonial infrastructure was critically vulnerable
- Puerto Rico's lack of political representation contributed to the inadequate response
- The deaths were preventable — they resulted from political and structural failures, not the hurricane alone

The Colonial Dimension:
The mortality study reveals how colonialism kills:
- Puerto Rico's electrical grid (PREPA) was in disrepair due to decades of colonial mismanagement and debt
- FEMA's response was slower and less adequate than comparable mainland disasters
- Puerto Rico's hospitals were already understaffed due to the brain drain
- The island's lack of voting representation meant no political accountability for federal response failures
- The Stafford Act treated Puerto Rico differently than states in disaster response funding

The difference between 64 and 2,975 is not a statistical error — it is a measure of colonial indifference.