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Hurricane Maria: One Year Later

Since Hurricane Maria made landfall, Direct Relief has delivered $70 million worth of medicines and supplies. The organization has also supported solar and infrastructure improvements to numerous local health centers.


Hurricane Maria

Noel Torres installs a solar power system at Clinica Iella in San Juan. Torres worked for months installing solar panels while living without power at his home in Aguadilla. The system at this clinic, funded by Direct Relief, will help maintain operations in the event of a power interruption. (Photo by Erika P. Rodriguez for Direct Relief)

It’s been nearly a year since Hurricane Maria wreaked havoc across the Caribbean, where brutal Category 4 winds whipped across the region, causing immense destruction and claiming thousands of lives.

The devastation caused by Maria was unprecedented. The storm wrecked Puerto Rico’s power grid, mangled infrastructure and disrupted the island’s medical system. After an initial blackout, communications came back online, allowing the world to see, frame by frame, the new reality the island would face.


In the midst of dire headlines over the past year, other stories have emerged, too – stories of neighbors helping each other to overcome enormous hardship.

A doctor who moved back to the island to care for patients in need.

Puerto Rican Doctor Moves Back to Give Back

A solar installer who continued to repair power systems at health centers, even when he lacked power in his own home.

Maria Left Him Without Power. Now He’s Making Sure Health Centers Can Power Through the Next Storm.

A community leader who worked constantly to make sure his neighbors had access to clean water.

A Puerto Rico Community Powers Its Future

A company that mobilized the largest philanthropic gift in its history – $100 million – to support the people of Puerto Rico in their recovery.

With $100 Million from AbbVie, Direct Relief & Habitat to Strengthen Critical Services in Puerto Rico

These are just some of the examples of selflessness and generosity that Direct Relief has had the privilege of witnessing over the past year, and without them, the recovery would not be where it is today.

Direct Relief’s Response to Hurricane Maria, By the Numbers

  • $70 million in requested medication and medical supplies
  • 733,267 pounds of medical aid
  • 456 shipments
  • 76 local community health centers and clinics, hospitals and other health providers supported
  • 791 kilowatts of solar energy power capacity installed and nearly 2 megawatts of battery backup at 14 health centers and non-PRASA communities
  • $12.3 million in cash grants to local organizations

Immediate Response – Puerto Rico

Since Hurricane Maria made landfall, Direct Relief has been working to solve short-term needs, as well as those that will protect the island’s healthcare system in the years to come.

Direct Relief has delivered $70 million worth of medicines and supplies, as well as supported solar and infrastructure improvements to numerous local health centers.

In the storm’s immediate aftermath,  Direct Relief had already connected with local health care providers and was mobilizing the resources needed to restart and sustain in their communities.

When Hurricane Maria hit Puerto Rico, four shipments of antibiotics, wound care supplies, and other medical supplies were already en route to the island municipalities of Culebra and Vieques.

Within days, Direct Relief was deploying additional shipments of medical aid to the hardest-hit areas, from Puerto Rico to Dominica and locations throughout the Caribbean.

With Access to Some Communities Still a Challenge, Helicopter Flights Get Key Medicines to Isolated Areas

On September 25, Direct Relief shipped out Emergency Health Kits for Hurricane Maria, with 600 hygiene kits and 12 medical backpacks to equip first responders. Additional shipments arrived later that week containing requested medicines, including antibiotics, inhalers, and hemophilia treatment. The last arrived via FedEx temperature-controlled transport just hours before the hospital anticipated running out.

At the time of delivery, staff at University Pediatric Hospital in San Juan estimated they had between 24 and 72 hours until their supplies of Factor VIII and IX blood-clotting drugs were depleted. Running out of the medication could have endangered the life of a young patient with hemophilia, who was being treated for renal bleeding before the donation arrived.

Urgently Needed Hemophilia Treatment Drugs Delivered to Puerto Rico Pediatric Hospital

Direct Relief also delivered multiple Emergency Health Kits, each containing enough essential medicines to treat 100 patients for 3 to 5 days. These went to the Puerto Rico Department of Health, as well as to a medical team of 75 doctors and nurses who met in San Juan to pick up supplies, then fanned out to 15 towns across Puerto Rico to provide medical care.

In the weeks that followed, Direct Relief fulfilled requests for medical aid from multiple medical distribution centers on the island that were providing dialysis care, as Puerto Rico was caring for about 120 dialysis patients from other parts of the Caribbean. These patients were housed in hotels but were likely to be placed in special-needs shelters and require long-term care. Direct Relief coordinated with a physician from the U.S. Public Health Service and Puerto Rico’s Emergency Operations Center to compile a list of insulin needs for those patients.

The response was a complex operation, spanning multiple countries and territories, many of which had severely limited communication and power in the storms’ aftermath. The organization coordinated deliveries of pre-packed kits and other services with several government agencies in Puerto Rico, including the Administración de Servicios Médicos, which runs eight hospitals and eight primary care clinics.

In addition to providing material support, Direct Relief committed an initial $350,000 in emergency operating grants for community health providers in Puerto Rico. Satellite phones were also shipped to the organization, enabling the members to communicate urgent medical needs in their communities.

Enabling community leaders and local organizations in Puerto Rico to continue their work has been at the heart of Direct Relief’s approach thus far, and will continue into the future as the recovery continues.

Immediate Response – Caribbean

In Dominica, more than 95 percent of buildings and infrastructure on the island was destroyed or damaged by the hurricane. Princess Margaret Hospital, which serves the island of about 70,000 people, was damaged but still functioning.  Direct Relief delivered shipments to the country’s head pharmacist, including an Emergency Health Kit and medication to help about 40 dialysis patients on the island keep potassium levels down while not receiving dialysis.

In Tortola, Direct Relief supported Peebles Hospital with a Hurricane Preparedness Pack that included pallets of specifically requested medical items, such as antibiotics, IV solution, oral rehydration salts, hygiene kits, and durable medical tents. Additional medicines were purchased to support 70 dialysis patients at the hospital, whose treatments went from daily to twice a week to conserve water and make use of fewer undamaged machines in the storm’s aftermath. The medication helped keep potassium levels down to extend the time patients could go between dialysis treatments.

In the U.S. Virgin Islands, at East End Medical Center, Direct Relief delivered five pallets of antibiotics, medicines for chronic diseases, and wound dressings. The center serves St. Thomas, St. John, and surrounding islands.

The Right Equipment at the Right Time

Radiologist Dr. Yania López Álvarez (center) reviews patient cases with residents Amanda Marrero González and Manuel Betancourt Robles at the Medical Center of Puerto Rico in San Juan, P.R., on May 10, 2018. Dr. López, Director of the Imaging Center of the University of Puerto Rico School of Medicine, returned to her homeland last year to work with the island’s population, leaving behind generous job offers on the mainland. Doctors who work in Puerto Rico must do more with less, with budget restrictions and infrastructure still in disrepair from Hurricane Maria. Direct Relief has purchased 3D mammography equipment so that Dr. López and her colleagues can conduct contrast-enhanced spectral mammography at the center. The equipment is expected to be operational by October 2018. (Photo by Erika P. Rodriguez for Direct Relief)
Radiologist Dr. Yania López Álvarez (center) reviews patient cases with residents Amanda Marrero González and Manuel Betancourt Robles at the Medical Center of Puerto Rico in San Juan, P.R., on May 10, 2018. Direct Relief has purchased 3D mammography equipment so that Dr. López and her colleagues can conduct contrast-enhanced spectral mammography at the center. (Photo by Erika P. Rodriguez for Direct Relief)

Specialty care remains scarce on the island, and many medical professionals have left the island to pursue more lucrative careers elsewhere. Making sure the doctors who chose to practice on the island have the equipment they need is also key.

Direct Relief funded the purchase of contrast-enhanced digital mammography technology to the center, run by Dr. Yania Lopez, a Mayo Clinic-trained doctor who returned to the island to practice breast imaging. Direct Relief is also replacing the hospital’s colonoscopy and laryngoscopy equipment that was damaged during Hurricane Maria, when voltage fluctuations made the equipment unusable.

About two-thirds of the patients served at the University Hospital lack insurance, have incomes below the poverty line, and are medically underserved. The imaging center sees between 250 to 300 patients monthly. The newly equipped space will allow Dr. López to care for patients on the island who otherwise would lack access to the help they need.

Businesses Step Up

In May, AbbVie, a research-based global biopharmaceutical company,  announced a donation to Direct Relief and Habitat for Humanity International of $50 million each to strengthen access to healthcare and housing in Puerto Rico.  This donation is an extension of the more than $4 million AbbVie provided following the unprecedented natural disasters of 2017.

Direct Relief is using the donation to rebuild and strengthen Puerto Rico’s primary healthcare system, better preparing it to withstand future hurricanes and outages of power or water. Direct Relief will support more than 60 community health centers and local healthcare facilities over a three-year period. These facilities care for a combined 352,000 residents across Puerto Rico.

To prevent interruptions in care, Direct Relief will provide the health centers with reliable energy sources including solar power, battery storage and generators, giving them the ability to produce their own clean water supplies. Direct Relief will also fund mobile health units, train and support an expanded medical workforce, increase access to a reliable supply of medicines, and institute telemedicine programs at select hospitals and health centers.

In August 2018, Direct Relief convened a meeting of more than 100 leaders of Puerto Rico’s nonprofit community health centers and hospitals, as well as other community leaders, who advised on how philanthropy can best restore and strengthen health services throughout the territory.

Other companies stepped up throughout the response with critical donations, including:

    • Abbott
    • Alcon Laboratories, Inc.
    • Apotex, Inc.
    • AstraZeneca
    • Baxter International Inc.
    • BD
    • GSK
    • Henry Schein, Inc.
    • Janssen Pharmaceuticals, Inc.
    • LifeScan, Inc.
    • Merck & Co., Inc.
    • Mylan
    • Omron Healthcare, Inc.
    • Pfizer
    • Purdue Pharma, L.P.
    • Unite to Light, Inc.

Equipping First Responders

Direct Relief staff load Emergency Medical Backpacks onto a helicopter bound for Vieques, an island off Puerto Rico's eastern coast that was badly impacted by Hurricane Maria. A new agreement reached this week will put more packs in the hands of emergency first responders so they're ready in case of disaster. (Photo by Donnie Hedden for Direct Relief)
Direct Relief staff load Emergency Medical Backpacks onto a helicopter bound for Vieques, an island off Puerto Rico’s eastern coast that was badly impacted by Hurricane Maria.  Direct Relief distributed 300 of these packs this summer so that emergency responders have them at hand during the next emergency. (Photo by Donnie Hedden for Direct Relief)

Direct Relief outfitted each member of Puerto Rico’s Medical Reserve Corps with Emergency Medical Backpacks so they’re ready to respond in the next emergency.

The group is made up of health professionals that respond to community health needs during a disaster. In the days and months after Hurricane Maria, Direct Relief staff distributed the Emergency Medical Backpacks to health providers so they could perform medical care in areas with limited access to hospitals and clinics, but the agreement with the island’s Medical Reserve Corps is the largest distribution effort of the packs on the island thus far, ensuring that every MRC member is ready to respond.

Each Direct Relief Emergency Medical Backpack contains supplies and equipment that meet a variety of common disaster-related health needs, including infection control, diagnostics, trauma care, and personal protection tools.

Power for the Next Emergency

To prevent interruptions in care caused by future natural disasters like Hurricane Maria, which knocked out power to some health centers for weeks, Direct Relief is providing dozens of local health facilities with reliable energy sources including solar power and battery storage.

The solar and battery systems are integrated with existing generators and the grid, giving each health center a true smart micro-grid system that can pull power from the most efficient source and never go dark.

Direct Relief and partners aim to put resilient power and backup power systems on at least one health center in all 78 municipalities on the island, ensuring everyone has a place to go to receive medical care after a storm.

Health centers aren’t the only locations on the island receiving a power boost. Direct Relief partnered with local nonprofit, Por Los Nuestros, to install solar-powered laundries so that community water supplies are more resilient and reliable during the next emergency or power outage.

Solar Laundromat Spins to Life in Puerto Rican Community

Technology for Emergency Response

Throughout the past year, Direct Relief has been using technology to connect the online community to on-the-ground care. Direct Relief used Facebook’s Crisis Response during one of the world’s largest-ever single-day vaccination campaigns that took place across Puerto Rico.

Thousands of people received flu shots Saturday as part of an island-wide vaccination campaign. (Tony Morain/Direct Relief)
Thousands of people received flu shots as part of an island-wide vaccination campaign. (Tony Morain/Direct Relief)

The daylong event was conducted by the VOCES Puerto Rico Vaccination Coalition, Puerto Rico’s Department of Health, the CDC Foundation, Direct Relief and others. A total of 9,426 people were vaccinated against influenza at 55 different locations across the island as a result. The vaccines, donated by Sanofi, were offered free of charge. Direct Relief used the Community Help tool to inform people where they could receive an immunization. Direct Relief has also partnered with Facebook to help the company refine their disaster response tools based on lessons learned from Hurricane Maria, as well as other emergencies.

Direct Relief also worked with several companies on a pilot project to connect health facilities with needed medicines should supply lines break during the next emergency. Direct Relief, Merck, AT&T, Softbox and Volans-i partnered in August 2018 to test emergency medical supply deliveries using drones designed to carry the types of medications people often lose access to in disasters, which can lead to health crises or death. The technology of the smart boxes allows for temperature-control when delivering products such as some of Merck’s vaccines. The non-refrigerated cargo can carry medications for asthma and hypertension for instance.

A drone lifts off during a test flight in Puerto Rico this week. Direct Relief, AT&T, Softbox, and Volans-i were all part of a pilot project that tested transporting medicine by drone, a system that could be replicated during the next emergency to reach areas cut off by storm damage or limited supply chains. (Photo courtesy of Merck)
A drone lifts off during a test flight in Puerto Rico in August, 2018. Direct Relief, AT&T, Softbox, and Volans-i were all part of a pilot project that tested transporting medicine by drone, a system that could be replicated during the next emergency to reach areas cut off by storm damage or limited supply chains. (Photo courtesy of Merck)

Researchers estimate that most deaths from Hurricane Maria in September 2017, were caused by the loss of access to medicines and health care, not by wind or water. As people were displaced from their homes, health centers lost power for weeks, and travel was extremely difficult. This likely contributed to an increase in deaths from chronic diseases that can be managed under normal conditions. The tests allowed drones to access challenging terrain in remote areas impacted during Maria, beyond the line of sight. The drone deliveries extend to remote mountain villages that were cut off from electricity and road access for months after Hurricane Maria, some of them for a time accessible only by helicopter.

Looking Forward

Maria’s impacts will be felt for many years to come. Direct Relief is committed not only to the continued recovery from Hurricane Maria, but the preparation and resilience of the health system in future emergencies.  Direct Relief has been able to provide for critical medical needs over the past 12 months, thanks to the generous outpouring of support from individuals, corporations, foundations, and healthcare companies.

Giving is Good Medicine

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