One month after Hurricane Maria hit Puerto Rico, life on the island is still grim.

Puerto Rico’s health care system is in “dire condition,” streets are “lined with mounds of soaking garbage mixed with mud, trees and sometimes dead animals,” and doctors on the island are bracing themselves for a public health crisis that’s “about to explode.” 

Half of hospitals were shut down at one point and community clinics, that serve the island's poorest people, aren't able to function. 

Amid all of that, a floating hospital with the capacity to serve 250 patients sits more than three-quarters empty

The reason? Well, it’s complicated. 

Known as the USNS Comfort, this “state-of-the-art” floating hospital was brought to the island by the Department of Defense more than two weeks ago to support the Federal Emergency Management Agency’s (FEMA) humanitarian relief efforts on the island. It’s staffed by more than 800 Navy personnel assembled from 22 commands, according to a Navy press release.  

But currently it sits mostly empty. 

CNN reported that patients need a referral from Puerto Rico’s Department of Health to be admitted and transferred to the center.

The ship’s captain, Kevin Robinson, told CNN that when it comes to getting patients to the ship, it was “not in my lane to make that decision,” and assured that medical staff on the ship do “have the capability to help.”  

“Comfort continues to receive patients that are referred to us from the hospitals on the island,” Lieutenant Commander David Lloyd wrote to Global Citizen in an email. “There is a process that was put in place when we first arrived in San Juan. [...] It has been working and is necessary to ensure the patients we receive are patients that are unable to be treated at a local hospital ashore.”

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According to Lloyd, patients who wish to be admitted to the Comfort must follow a three-step process. 

Critical patients first go to the nearest hospital; second, their doctor contacts the medical coordinating center, Centro Medico; and third, the medical coordinating center will determine whether patients should be sent to one of four places: a Puerto Rican hospital capable of providing care, the Centro Medico, the US Army Combat Support Hospital in Humacao, or the USNS Comfort. 

To date, according to Lloyd, the Comfort has received 119 patients, with 33 currently on-board. 

“Only patients with critical needs requiring specialized care will be transferred to USNS Comfort,” Lloyd wrote. “When the patient's specific care needs have been met, the patient will be discharged to an appropriate care facility.” 

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For some Puerto Ricans in need of immediate aid, such as those who are currently housed in temporary medical facilities in schools, churches, and elsewhere, this is not so easily accomplished. 

That includes Sammy Rolon, who suffers from cerebral palsy and epilepsy and is currently housed at a clinic inside a school, CNN reports. 

"He can become acutely ill if he continues to be (at the school)," Rolon’s doctor, Jorge Rosado, said. "It's very frustrating. I know they have the capacity; they have the medical staff; they have the supplies. To hear there's only 33 patients in such a big mobile hospital — it's tough."

Read More: Hurricane Irma Leaves As Many As 150,000 Puerto Ricans Without Safe Drinking Water

Puerto Rico Governor Ricardo Rosselló has said that the government is working to update this process, which could allow the remaining 217 beds to be filled. 

"The disconnect or the apparent disconnect was in the communications flow," Rosselló said. "I asked for a complete revision of that so that we can now start sending more patients over there.” 

But the situation at the USNS Comfort is just the tip of the iceberg when it comes to the island’s public health crisis.

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Immediately after Hurricane Maria struck Puerto Rico, health care centers across the island experienced power losses, and had to rely on backup, often fuel-based generators to continue operations. 

One month after the hurricane, only 18% of Puerto Ricans have power, Newsweek reports. The government hopes to restore 30% of power by the end of this month. 

The San Jorge children’s hospital was among the medical centers that experienced electricity losses in the aftermath of Hurricane Maria, according to the Guardian

Read More: This Award-Winning Chef Is Serving Meals to Hungry Puerto Ricans Every Day

As the government works to restore power, public health volunteers are reporting cases of nasty diseases spreading to vulnerable populations. 

According to the Miami Herald, at least four people have died from leptospirosis — a disease caused when rodent urine enters into drinking water. 

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Doctors at one of the country’s 86 public health clinics have also noted a rise in the cases of pink eye, skin rashes, and diarrhea, which can be caused by improper access to safe drinking water. 

In the San Juan metropolitan area, raw sewage from a waste treatment plant is leaching into a river that feeds Lake Carraizo, where half of drinking water is sourced from, causing the river to turn “greenish-brown,” ABC reports

Despite the emerging public health crisis, funding for community health centers is in jeopardy, according to FiveThirtyEight. To date, 44 have died as a result of Hurricane Maria, but without immediate assistance, this number threatens to skyrocket even higher. 

As one doctor told the Press Herald: “We’re already building the next disaster.”


Defeat Poverty

US Navy Says Mostly Empty ‘Floating Hospital’ Off the Coast of Puerto Rico Is for Emergencies Only

By Phineas Rueckert