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Dr. Yousef Motii conducts medical outreach in the destroyed Spanish Lakes neighborhood in Ft. Pierce, Florida. Motii is a clinician at Oceana Health, which has been providing medical services to residents impacted by recent hurricanes. (Photo by Bimarian Films)
Power Outages from Hurricanes Helene and Milton Closed Clinics at 54% of Safety-Net Healthcare Providers Surveyed in FL, NC, SC and GA: Direct Relief Study
Nearly 28,000 Medical Appointments Canceled;
$12.9 Million in Revenue Lost;
Expensive Medicines and Vaccines Spoiled
When Hurricane Helene and Hurricane Milton barreled across Florida, North Carolina, Georgia, and South Carolina one after the other in late September and early October 2024, they caused widespread electrical power outages that forced temporary closures at more than half of safety-net healthcare providers responding to a survey conducted by Direct Relief.
Community health center and free clinic survey respondents, relative to the paths of hurricanes Helene and Milton
Among 80 community health centers and free & charitable clinics responding to the survey, 43 (54%) said power loss forced the temporary closure of at least one clinic site.
The power outages led to nearly 28,000 canceled or delayed patient visits, an outcome tied to negative health outcomes including higher mortality. Nearly one-fourth (19) of the providers were forced to discard temperature-sensitive medicine or vaccines when their refrigerators lost power. Twenty-three organizations reported losing revenue totaling $12.9 million while they were closed.
The information comes from one of the broadest surveys yet conducted on how power outages caused by natural disasters impact healthcare. Direct Relief distributed surveys to 394 federally qualified health centers (FQHCs) and free & charitable clinics and pharmacies (FCCs) in the four states most impacted by Hurricanes Helene and Milton: Florida, Georgia, North Carolina, and South Carolina. The 80 organizations responding to the survey include 25 FQHCs and 55 FCCs, which operate a total of approximately 500 clinical sites. All safety-net organizations in the four states combined serve more than 850,000 patients.
Among 80 survey respondents:
Fifty organizations (62%) lost power at one or more clinic sites in the wake of the hurricanes
Forty-seven organizations (59%) were forced to close at least one clinic site due to any hurricane-related cause
Forty-three (54%) said power loss forced the temporary closure of at least one clinic site
Of those 43, 26 cited both power loss and other factors, such as staff safety or unavailability, as reasons for closure
Four organizations said they closed clinic sites for reasons that didn’t include power loss
The total numbers of closed clinics and cancelled patient visits in the four states are almost certainly much higher, as the 80 respondents represent fewer than a fifth of the FQHCs and FCCs in these states.
Lost access to care poses a serious risk to patients when they are unable to receive medicine or treatment for chronic conditions like diabetes and hypertension, or acute problems like infections. A growing body of research shows that hurricanes and other natural disasters lead to a higher-than-normal long-term death rate in affected communities, in part due to lost access to healthcare. The long-term increase in deaths from hurricanes far exceeds the number of lives immediately lost from storm-driven water and wind.
FQHCs and FCCs comprise the country’s healthcare safety net. They serve both rural and low-income urban communities where healthcare options are limited. Among patients of FCCs in 2024, 84% lacked health insurance. FQHC patients have higher rates of chronic conditions like diabetes and high cholesterol, and 32% report their health as fair or poor, vs. 18% of the general U.S. population. Poorer health makes people more medically vulnerable during and after an extreme weather event.
“Health centers and clinics are often the bedrock healthcare providers in their communities. When power goes out, their ability to deliver critical, even life-saving services is compromised, leaving vulnerable patients at serious risk.”
– Sara Rossi, Managing Director of the Health Resiliency Fund at Direct Relief
Power loss can cause significant direct financial costs to safety-net healthcare facilities, which operate on extremely narrow margins. These costs come from lost revenue, spoilage of vaccines and medications, equipment damage, data loss, and increased operating costs.
Direct Relief delivered emergency medical backpacks and hygiene kits to Oceana Community Health Clinic in Fort Pierce, Florida (Photo Credit: Sofie Blomst/Direct Relief)
The power outages at individual clinics lasted between several hours and nearly three weeks, with a median outage of just under two days (47 hours), and one organization reporting a 19-day outage. Power outages cost FQHCs an average of $612,000 in lost revenue from missed patient appointments. Spoiled insulins, vaccines, and other temperature-sensitive medications can add up to tens of thousands of dollars in losses – one clinic reported losing $60,000 worth of vaccines.
While hospitals are required to have backup power systems for emergencies and typically must keep enough fuel on hand to run generators for at least four days, FQHCs and FCCs have no such mandates. Only 12% of responding organizations had backup power at all of their service delivery sites, 38% had backup power at only some of their sites, and 50% had no backup power at all. Of the 41 facilities that had at least some backup power, seven (17%) reported that their backup power had failed during the storms, four of them due to running out of fuel.
While loss of power was a significant disruptor of clinics’ ability to operate, individual clinics faced a wide variety of additional challenges that contributed to or extended their closures. Some sites, including in western North Carolina, were heavily damaged by flooding – or even destroyed, like Mountain Community Health Partnership’s facility in Micaville, NC. In other cases, staff members were unable to travel to work due to damaged roads, or because they had to relocate after their homes were damaged. Appalachian Mountain Community Health Centers in Asheville, NC, had no running water. In St. Petersburg, Fla., Evara Health was forced to shut because school closures required staff members to stay home with their children.
Healthcare today is almost completely dependent on electrical power. Without power, clinics can’t operate. They are unable to examine patients, schedule appointments, access electronic health records, take x-rays, clean teeth, fill cavities, or dispense prescriptions. Lost power to pharmaceutical refrigerators spoils insulin, vaccines and other temperature-controlled medicines, reducing medicine availability and causing financial losses. Power runs dental tools, lights up windowless exam rooms, and – in one of the hottest and most humid areas of the country – keeps the clinics air-conditioned.
“If this building loses its power, I’m pretty much dead in the water for that day, and then I’m in a scramble mode to try and keep my vaccines alive. Without power, my X-ray’s down, my ultrasound’s down, my electronic health records are usually down.”
– John Newman, Executive Director and Chief Medical Officer at Volunteers in Medicine in Hilton Head Island, SC
The free clinic’s dental clinic shuts down without power, as does the water supply to the hydroponic farm that grows healthy produce for its patients.
Power outages after Hurricane Helene forced Volunteers in Medicine to close its clinic on Daufuskie Island for more than eight days, and its Hilton Head Island clinic for two days, leading to more than 300 missed or delayed patient visits.
Patient Visits Canceled
Other findings from the survey:
One in three organizations lost power at multiple sites
Sixteen of the 25 responding FQHCs lost power at more than three clinic sites
Twenty-three of 37 (62%) Florida organizations surveyed lost power, compared to six of nine (67%) in Georgia, 12 of 21 (57%) in North Carolina, and eight of 12 (75%) in South Carolina.
Forty-four clinics reported 27,857 canceled patient visits. The median per clinic was 50, and the mean was 633.
Forty-five clinics have patients who rely on electricity-powered durable medical equipment, some of it required to sustain life, such as oxygen concentrators. The median number of patients on these devices per organization was 20.
“It’s shocking when you look at these numbers and you realize the extent to which these disruptions impacted these organizations,” said Gianna Van Winkle, Director of Emergency Management Programs at the Florida Association of Community Health Centers, which helped Direct Relief conduct the survey in Florida.
In Florida alone, FQHCs reported:
Over 35 individual sites losing power across 12 organizations
A median of 13 hours and maximum of 315 hours with no power
10,630 total patient visits canceled or missed due to power outage across 12 organizations, with a median of 350 per organization
“Those 10,000 visits missed are 10,000 opportunities to not only provide folks with medical care, but also, in a time of great need, to provide them with reassurance that there is support available in their community.”
– Gianna Van Winkle, Director of Emergency Management Programs at the Florida Association of Community Health Centers
Hurricane Helene tore across the Georgia border early the morning of Sep. 27, after cutting through the Florida Panhandle in less than two hours. It took out power for 12 of East Georgia Healthcare’s clinics for periods ranging from 58 hours to 207 hours. The Swainsboro-based FQHC, which serves patients in 14 Georgia counties, had to cancel nearly 2,000 patient visits and lost $159,000 in revenue.
In Bradenton, Fla., Turning Points (a free clinic and homeless services center) sits a few miles from where the Manatee River empties into the Gulf of Mexico. It lost power for 16 hours after Hurricane Helene and 28 hours after Hurricane Milton, leading to 60 canceled patient visits. Without power, the clinic had no air conditioning, amid temperatures in the upper 80s and humidity above 75%. It had no lighting in its windowless exam rooms, and – critically – no access to its medical and dental electronic medical record systems. Turning Points’ closure also cut off access to vital services it provides for local homeless people, including food, showers and laundry. The organization also reported $40,000 in infrastructure damage.
“Access to a patient’s medical chart is crucial for providing care. I need to see your test results, what prescriptions we prescribed you, so that I can make informed decisions. We’re not going to put their health in jeopardy.”
– Kathleen Cramer, Executive Director at Turning Points
After the twin hurricanes last fall, Turning Points acquired a Starlink satellite-based internet system for backup use, because the clinic’s local internet services provider is consistently unreliable.
Federally qualified health centers care for more than 32 million patients (nearly 1 in 10 U.S. residents), including one in five rural residents, one in five uninsured people and one in three people living in poverty. FQHCs are often the main healthcare provider in rural and low-income urban communities across the country, treating a mix of insured and uninsured patients. These safety-net organizations typically provide services including primary care, pediatrics, obstetrics and gynecology, mental health and substance abuse services, and more.
In the wake of a disaster, FQHCs provide continuity of care for patients who have chronic medical conditions and need uninterrupted access to medications, and they also alleviate pressure on local emergency rooms, said Taina Lopez, Director of Emergency Management at the National Association of Community Health Centers. “They’re a haven for the communities that they serve.”
Direct Relief helps partner Mashburn Medical Center with medicine and emergency supplies as beneficiaries recover from the devastation of Hurricane Helene.
After hurricanes, FQHCs and free clinics, which are trusted community resources, often act as essential hubs for people affected by the disaster: many distribute bottled water and food, help connect people to disaster relief and other public services, and educate people about available resources like rental assistance programs. Health center staff responding to storms or flooding have organized pharmaceutical deliveries for patients after floods, called patients post-disaster to check in on healthcare needs or done bedside visits for less-mobile patients, provided mental health support to first responders as well as patients, and even helped patients clean out flood-damaged houses.
Free & charitable clinics and pharmacies care for 1.7 million Americans – including over 650,000 new patients last year – with six million patient visits annually. They typically provide primary and preventive care, mental health services, and access to free or low-cost medicine, and may provide additional services including dental care.
Missed medical care – particularly in the often chaotic, high-stress aftermath of a disaster – can be much more consequential for free clinic patients than it is for financially secure Americans.
“They could have multiple jobs, or jobs that do not allow them to get out during the day. They may have to depend on somebody to drive them. They may have to depend on a family member to come because they do not speak English. When you have that delay, there is a chance that that patient may not be coming back.”
– Ariana Gordillo De Vivero, Senior Director of Strategic Initiatives at the National Association of Free & Charitable Clinics.
Operational Disruption, Loss of Refrigerated Medicines and Vaccines
Closing clinics for several days also causes a cascade of canceled appointments that must then be rescheduled, in clinics that often operate at full capacity and whose own staff may have been displaced by the disaster.
“We’re busy, so if I cancel this week, it’s not like next week is empty and I could just push them all to the next week,” said Newman at Hilton Head’s Volunteers in Medicine. “Then it’s this absolute scramble the next week trying to do two weeks’ worth of work in one week.” He notes that some of the specialist physicians who volunteer at the clinic are only available a couple days a month, so a day of cancellations may mean long delays for those patients.
Direct Relief partners with clinics in Western NC like Good Samaritan Clinic in Morganton to provide medical care, and prescription medications to residents without private insurance, or the financial resources to afford such care.
Lost medicine is another significant cost. Nine FQHCs and 10 free & charitable clinics responding to Direct Relief’s survey reported having to discard refrigerated medicines and vaccines due to power loss.
South Central Primary Care, a Georgia FQHC with 14 sites, lost $60,000 worth of vaccines and $500,000 in revenue. The organization’s representative related the following: “Hurricane Helene took out our entire service area. All sites were down for over one week. [We] started opening back up when possible, the next week. It took an additional two weeks after that for our patient volume to be where it was before the storm. Just because our offices were open did not mean that our patients had the ability to travel. We swapped staff around between sites. We had two employees who lost their homes and were living in tents.”
Spoiled medicines don’t just come with a financial cost: Health centers have reported an increased need for Tdap vaccinations, which require cold-chain storage and transport, in the aftermath of hurricanes, as people come into contact with potentially contaminated water. Insulin, another cold-chain medication, is also frequently requested by patients with Type 2 diabetes who have been separated from their medications. Power losses can destroy large caches of these medications, which must be available to prevent tetanus infections and complications from diabetes.
Hurricane Helene cut off Greenville Free Medical Clinic’s power for between 24 and 200 hours at its four locations in western South Carolina, and knocked out its internet service for 12 days due to damaged power poles.
“The only reason we did not lose approximately $300,000 worth of vaccines, insulins, or other medications is because our hospital agreed to store our inventory until power was restored,” the organization reported. “This was a very tedious process to move the product over and back from the hospital system, and had to be undertaken in the very early hours after the storm, posing a safety risk for staff involved.”
Hurricane Helene cut off Greenville Free Medical Clinic’s power for between 24 and 200 hours at its four locations in western South Carolina, and knocked out its internet service for 12 days due to damaged power poles.
Note: In July 2025, Direct Relief’s Power for Health program approved a $400,000 grant to Greenville Free Medical Clinic to cover the cost of a solar microgrid design and installation process, including project management and five years of operations and maintenance costs. The organization applied for funding after Hurricane Helene, and the grant is co-funded from Direct Relief’s Hurricane Helene fund and Power for Health.
Among the survey respondents, 38% of organizations reported an increase in patients seeking care after the storms, including 21% that reported an increase in patient volume of up to 10%, and 16% reporting an increase in volume of 10% or more.
Medical aid arrives from Direct Relief for Oceana Health Community Health, a free clinic responding to Hurricane Milton impacts in Florida. (Photo by Bimarian Films)
Two free & charitable clinics in Florida – Premier Mobile Health Services in Ft. Myers and Oceana Community Health in Boynton Beach – reported a surge of more than 50% in patient volume after the storms. Ft. Myers, where Premier Mobile Health Services is located, is about 75 miles from where Hurricane Milton struck land. The town experienced significant flooding, a tornado and widespread power outages. The area was still recovering from flooding from Hurricane Helene’s storm surge when Milton roared through the area 13 days later. Premier said additional patients came to their facilities for reasons including lost access to primary care doctors, storm-related injuries, or conditions brought on by disaster-related stress.
Other organizations also reported a surge in demand from new patients who lost access to their regular healthcare providers. Fallen trees, washed-out roads and flooding made it impossible for many to reach their usual primary care sources. Others were displaced far from their homes.
Direct Relief helps partner Blue Ridge Health in Hendersonville, NC with medicine and emergency supplies as beneficiaries recover from the devastation of Hurricane Helene.
Health clinics replaced insulin and other essential medicines for patients who had lost their supplies during the storm or were unable to refill prescriptions at their usual pharmacies. Others reported increased post-hurricane demand for care for lacerations, for injuries suffered during clean-up operations, and for dental emergencies.
Blue Ridge Health, a large FQHC in western North Carolina, saw flooding, building damage, and loss of running water across its 68 sites, which all lost power for at least four days, with some out of power for over a week. The organization reported $400,000 in lost revenue and $700,000 worth of damage to infrastructure from flooding. Its clinics were also affected by loss of water supply, building damage, flooding, unavailable staff, and loss of telephone and internet connectivity.
As Blue Ridge’s clinics reopened, providers saw increased demand for behavioral health services addressing disaster-related trauma, and increased need for medications due to surrounding medical clinics remaining closed, in addition to more overall demand for care for acute and chronic conditions.
In Hendersonville, NC, Henderson County Free Medical Clinic saw more than a 25% increase in patient demand, which it attributes to other healthcare organizations closing their facilities, or to patients being unable to reach their providers due to washed out roads and dangerous travel conditions.
Organizations reported a total of $12.9 million in lost revenue from the outages. Of the 21 FQHCs that reported power loss, 16 said the power loss led to loss of revenue. Among those 16, power loss from the storms cost the FQHCs an average of $803,000 in lost revenue, and a median loss of $350,000.
At free & charitable clinics, revenue loss was less. As their name indicates, free clinics provide much of their care without charge. Of the 29 FCCs that reported power loss, only seven reported revenue loss, with an average loss of about $10,200 and a median loss of $5,900.
Revenue loss for organizations with power outages at one or more sites* (n = 23)
Direct Relief’s study adds to a growing body of research on how natural disasters impact public health beyond the immediate physical danger of water, wind and fire.
A 2024 study in Nature found that that long-term excess deaths attributable to hurricanes can be 300 or more times higher than immediate deaths. The disruptions hurricanes inflict upon people’s lives set them on a path to poor health that eventually cuts short their lives. The authors tracked the effects of all 501 hurricanes that hit the continental United States between 1930 and 2015 and found that while the average hurricane caused 24 immediate deaths, the storms on average led to between roughly 7,170 and 11,430 additional deaths in the 20 years after landfall. The data showed that 13% of deaths in Florida, 11% of deaths in North Carolina, and 9% of deaths in South Carolina during this period can be traced to their hurricane-prone climates.
Migrant Health Center about to receive medical supplies from Direct Relief following the path of Hurricane Maria through Puerto Rico. (Photo by Angel Valentin/Freelance)
Although the death toll in Puerto Rico from 2017’s Hurricane Maria was officially 64, a 2018 study in the New England Journal of Medicine found the hurricane caused a total of 4,645 additional deaths and a 62% increase in the mortality rate in the 102 days after the storm, compared with the same period in 2016.
“Disasters trigger complex cascades of events that ultimately may cause additional future mortality,” the authors of the Nature paper wrote.
A study by Direct Relief and others published in June 2025 in the journal Disaster Medicine and Public Health Preparedness detailed the healthcare impacts of disrupted healthcare to people affected by the 2022 Oak Fire in Mariposa County, Calif. Of the respondents, one in in five (21%) missed or delayed medical appointments due to the fire, and 45% of those people reported months-long delays in receiving care. 21% reported harm to their health from delays in medical care related to the fire. The people who experienced the most delays had more medical conditions (mean 4.1 vs. 2.4) and used more medical devices (median 4 vs. 2), making them more vulnerable to loss of care.
“Interruptions to health care access during and in the aftermath of disasters impact health long after the initial insult,” the authors wrote.
Loss of power after hurricanes has been shown to lead to more deaths through mechanisms ranging from carbon monoxide poisoning from backup generators to overheating after the loss of air conditioning. Twelve residents of a Miami-area nursing home died from heat exposure after 2017’s Hurricane Irma cut off power for their air conditioning. A subsequent analysis found that nursing home residents who experienced power loss from Hurricane Irma had a 25% higher chance of dying within seven days compared to those who did not.
In March 2025, Direct Relief surveyed 394 federally qualified health centers (FQHCs) and free & charitable clinics in the four states most impacted by Hurricanes Helene and Milton. Each of these organizations operates one or more clinic sites. FQHCs generally have multiple care delivery sites across their service regions, while free & charitable clinics most commonly (but not always) have only a single location.
The 394 organizations surveyed included 145 FQHC organizations and 249 free & charitable clinic organizations. That represents most of the FQHCs in the four states, according to data from the Health Resources & Services Administration, and 84% of the estimated 298 free & charitable clinics and pharmacies in the region, according to the National Association of Free & Charitable Clinics. The 80 respondents included 25 FQHCs (about 17% of regional FQHCs) and 55 free & charitable clinics (about 19% of FCCs).
