Hurricane Maria killed 4,600 in Puerto Rico, 70 times official toll

That number was about nine times the official death toll. The Harvard survey conducted among 3,299 households suggests 4,645 more deaths occurred between the storm's September 20 landfall and December 31 than would have been expected under normal conditions. In the aftermath, deaths could be attributed to lingering safety problems, illnesses brought on by unsanitary conditions or the "loss of necessary medical services", the authors wrote.

In the 102 days since the hurricane hit the island, an estimated 4,645 people died, according to the study published on Tuesday by US-based The New England Journal of Medicine. They used the responses to determine there were 14.3 deaths per 1,000 Puerto Ricans from the date that Hurricane Maria hit through the end of the year.

The study noted that calculating a reliable death toll following natural disasters is hard, but that it is a crucial part of the recovery process.

The team from Harvard arrived at its much-higher estimate by surveying 3,299 randomly chosen households across the island earlier this year. The researchers then extrapolated that figure to the total population of Puerto Rico, which is 3.4 million people. Yet the official government count still stands at 64.

Meanwhile, a couple of media organizations have gone to court to obtain more details on the deaths reported in Puerto Rico previous year. "Many deaths were caused by poor management of the crisis".

Among the deaths the researchers tallied through their survey, almost 1 in 10 were a direct result of the storm, and one-third could be traced to "delayed or prevented access to medical care" as a result of the storm. They applied the rate to the entire country to find how many "excess deaths" there were. Still, "The way this is done, by interviews with people in different barrios in Puerto Rico, it seems to me that someone could report a death as associated with the hurricane when it was not".

Maria, a major hurricane with winds close to 150 miles (241 km) per hour, caused an estimated US$90 billion in damage to an island already struggling economically and many residents have subsequently left.

Natalio Rodriguez Lebron, 77, for example, died in Maunabo, Puerto Rico, in January.

"It's a bit of a contradiction because they are saying they want to be transparent, but this is one of the many things that they're doing that just doesn't add up", Rivera said. Previously, officials had expected the George Washington University report to be released this spring, before the Atlantic hurricane season, which begins on June 1. A proper and timely count of deaths should make it easier to get aid to survivors - and perhaps prevent secondary deaths owing to a lack of doctors, hospitals and medicines.

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