Hurricane Maria wreaked Puerto Rico, Dominica, and the US Virgin Islands, with catastrophic impacts and years of recovery lying ahead. Hurricane Irma caused widespread devastation across the Caribbean and had a catastrophic impact on the southeastern United States. Hurricane Harvey made its first landfall in Texas as a Category 4 hurricane on August 25th, 2017, breaking records and causing catastrophic flooding and damage across the Gulf Coast.

It may take a while before we have a full understanding of the extent of damage and long-term recovery needs. NCDP is closely monitoring the evolving situation and looking at factors that will improve the long-term recovery of the affected communities and their children. Listed on the left are links to pages containing resources for immediate and long-term recovery, custom mapping applications, and media appearances from NCDP experts providing insight into response and recovery efforts.

Dr. Irwin Redlener: Death Count on Puerto Rico Likely “Orders of Magnitude Higher” Than Reported

October 13, 2017

Dr. Irwin Redlener, Director of the National Center for Disaster Preparedness at Columbia University, released the following statement regarding his concerns with the reported death toll in Puerto Rico from Hurricane Maria:

Official government reports indicate that 45 people in Puerto Rico have passed away as a result of Hurricane Maria. But my perspective leads me to believe that this number is orders of magnitude higher.  

The causes of continuing fatalities that can legitimately be attributed to a disaster like Hurricane Maria are not straightforward, but it is essential to look beyond the immediate casualties – for instance, from falling debris or drowning –  to fully appreciate the consequences of this disaster.

Local officials may well be struggling with procedures and capacity in their efforts to conduct this tragic count, but it is critical that the most accurate information available is utilized on the ground to warn people about ongoing public health threats and to promote additional assistance.”

Here are some of the causes of persistent casualties directly related to the hurricane and its aftermath:

  • Loss of access to medical care for people with chronic or complex medical conditions (heart disease, cancer, kidney failure, hypertension, asthma, diabetes and more)
  • Interruption of the medication supply chain, including for oxygen.
  • Infections from contaminated wounds
  • Loss of power for electricity-dependent medical equipment (dialysis, breathing support devices, etc.)
  • Contaminated water supply with biological or chemical contaminants
  • Interrupted electricity in hospitals
  • Communication and transport challenges for people with acute life-threatening medical conditions
  • Accidents related to people trying to repair or rebuild homes, mishandling of electrical dangers
  • Long-term mold infestations

Dr. Redlener is available for interviews regarding this and other topics related to Hurricane Maria or other disasters.

Understanding the Impact of and Response to Hurricane Harvey Posting #1

September 1, 2017

Americans are watching in horror as Hurricane Harvey, now considered a 1,000 year flooding event, wreaks damage in Houston, America’s 4th largest city, and across a large swath of smaller cities, suburban communities and isolated rural communities. The immediate response is still in progress and the recovery will be epic. We believe that this will be the most complex, the costliest, and longest disaster recovery process in U.S. history.

What we have seen so far might be summarized as follows:

  • In contrast to what saw in response to Hurricane Katrina in 2005, the federal response to Hurricane Harvey has been particularly rapid and well organized.
  • Although the storm worsened much faster than anticipated, and the flooding was monumental, confusion seemed to reign with respect to messaging from state and local officials, particularly around when and whether citizens and institutions should evacuate.
  • We have seen extraordinary volunteerism by citizens wanting to help – this has saved countless lives.

Here are some thoughts about initial priorities and what to watch for:

  • Priority 1 should ALWAYS be about search and rescue and saving lives. But officials should be already beginning to think about recovery, and thoughts about quantity, quality and appropriateness of shelter should be raised.

We should monitor the success of the initial response efforts using five key metrics:


Have we kept fatalities at an absolute minimum?


How well have officials demonstrated an explicit capacity to identify and protect vulnerable populations: children, elderly, people with disabilities, people with limited resources?


Were institutional evacuations – hospitals, long-term care facilities, prisons and so on – timely, safe and effective?


Are separated families being rapidly reunified?


Is public messaging “evidence-based”, consistent across all agencies and government communications, and culturally and linguistically accessible?

Other Major Considerations: Evacuation and Sheltering

  • Even temporary shelters must accommodate infants and children (diapers, formula, toys, etc.), the elderly and people with acute or chronic medical conditions. Shelter managers frequently have not thought about these issues (in Texas, but also after Katrina, Sandy, etc.). This includes shelters in or near the affected areas, as well as locations far from Houston.
  • Access to “psychological first aid” and long term support needs to be available to survivors and responders. This is not yet fully available in the storm affected communities.
  • Evacuation and temporary sheltering may be very prolonged. Meantime, what is happening to schools, community activities, access to regular medical providers, etc.?
  • The decision to evacuate is very difficult! Especially so in Texas which has ‘home rule’, where almost all decisions are made locally. For e.g. when the governor was saying people should evacuate, Houston mayor recommended sheltering in place.

Government at all levels, in addition to private and voluntary organizations and health systems, are standing up emergency health care clinics and systems. The federal government under the auspices of the Federal Emergency Management Agency (FEMA), the Assistant Secretary for Preparedness and Response (ASPR) has been very forward leaning in this, and the Department of Defense is now actively supplementing medical care access points.

Other Problems in the Wings

  • It is unclear what’s happening in the dozens of affected counties that are not getting the visibility that Houston is/will be receiving.
  • What about access to medicines and medical equipment during and after the disaster? Are supply chains active and functioning?
  • Water is contaminated with sewage, chemicals; standing water a problem (infectious issues, etc.)
  • Responder stress can be severe and must be managed.


This may be the longest and most expensive disaster recovery in U.S. history.

  • There are already reports of serious damage and malfunctioning of water and sewage systems.
  • Mold will be a major problem as the water level recedes.
  • Disaster case management is needed.
  • According to the Consumer Federation of America, only two of 10 homeowners in the Houston area have flood insurance coverage. Most of Houston falls outside the National Flood Insurance Program’s designated hazard zones, and most homeowners not been required to have flood insurance. Homeowners without flood insurance can possibly apply for federal disaster relief benefits, but those come in the form of low interest loans, a burden for those already struggling with too much debt. Despite the damage caused by Hurricanes Katrina and Sandy and other storms, only 12 percent of homeowners nationwide had flood insurance in 2016.

Poverty and Disasters

  • 40% of kids in Houston live in poverty. With few resources even prior to Harvey, challenges will be substantially exacerbated challenges as a result of the catastrophe.
  • Socioeconomic conditions affect survival and recovery.


  • Recovery could cost over $100 billion.
  • Families are facing immediate loss of income – even for basic survival.
  • Businesses may be shutdown indefinitely.
  • The tax base will be significantly disrupted.

Lessons learned and not learned from prior events (Harvey v. Katrina v. Sandy, etc.)

  • This time around, federal authorities are far better prepared, with Brock Long as FEMA director, Dr. Robert Kadlec, as Assistant Secretary for Preparedness and Response, etc.
  • The complexity of some of the challenges that state and local official faced in prior events are again being seen (e.g. 911 system being overwhelmed, evacuation challenges).
    • Message consistency is essential but a challenge to implement across affected counties, cities, and from the governor’s office.

National Center for Disaster Preparedness: What Are We Doing?

  • NCDP is closely monitoring the situation, developing tools to feed real time data with a hands-on mapping experience.
  • NCDP is maintaining contact with federal officials.
  • We are developing tools to help assess impact of the storm on children, and the institutions that serve them (schools, day care, community programs, nutrition programs and so on)
  • We are working with partners, especially the Children’s Health Fundin organizing medical care in shelters and soon, potentially, in the centrally affected areas hit by Hurricane Harvey.


Stay tuned for updates!

Authored by:
Irwin Redlener, MD, Director, National Center for Disaster Preparedness
Jeff Schlegelmilch, MBA, MPH, Deputy Director, National Center for Disaster Preparedness