NEW YORK — It was not until after watching her home in Aguada, Puerto Rico, fill with water and the roofs blow off houses during Hurricane Maria that Suzette Sanchez began noticing those around her dying.
There was the family friend whose heart surgery had to be postponed when the hospital closed.
There was the volunteer who contracted leptospirosis, a bacterial infection often caused by contact with rat urine, while cleaning.
“When the government said only 64 people died, I knew it wasn’t true because I had many friends that lost a loved one after the storm,” Sanchez said.
Days after a new study from researchers at the Harvard T.H. Chan School of Public Health estimated that the death toll from Hurricane Maria may have been as high as 4,645 people, mainly because of delayed medical care, hundreds of protesters gathered Saturday in the shadow of the United Nations to demand that the international organization audit the number of casualties.
The Puerto Rican government is reviewing its official death toll from the storm, which it said in December was 64.
“If it were 5,000 kittens, there would be outrage,” said Elizabeth Yeampierre, executive director of Uprose, a Latino organization in Brooklyn. “If it was 5,000 dogs, there would be outrage. If it was 5,000 blonde-haired, blue-eyed women, there would be outrage.”
The protest was organized by the Collective Action for Puerto Rico, a coalition of faith-based and labor organizations. Protesters held signs saying “Puerto Rican lives matter” and “If you are not angry you are not paying attention.”
They took off their shoes as a symbol of the people who died as a result of the storm but who were not immediately counted, and called for more attention to be paid to the hurricane’s aftermath in the form of more assistance for people still struggling on the island as a new hurricane season begins.
“Sisters and brothers in this country forget that the people of Puerto Rico are our fellow Americans,” said Linda Sarsour, who was one of the organizers of the Women’s March in Washington. “They deserve to be treated just like any American in any part of this country.”
U.N. officials did not immediately respond to a request for comment.
Researchers behind the study, which was published Tuesday in The New England Journal of Medicine, visited close to 3,300 randomly selected households across Puerto Rico. They found that 38 people from those households died in the months after the storm.
Using their independent estimate of the number of deaths, researchers calculated the mortality rate after the hurricane and compared it with mortality rates from 2016. Researchers found a 62 percent increase in the mortality rate from Sept. 20, 2017, when the hurricane hit, through Dec. 31, 2017, compared with the same period in 2016.
The study found that the official death toll of 64 was a “substantial underestimate of the true burden of mortality after Hurricane Maria” and that the estimated 4,645-person death toll could exceed 5,000.
Puerto Rican officials said in December that they planned to revise the official death toll, counting direct and indirect storm deaths. The commonwealth commissioned a study on Hurricane Maria deaths from the Milken Institute School of Public Health at George Washington University, which is expected to release the first part of its review this summer.
The Centers for Disease Control and Prevention attributes deaths to a hurricane such as Maria if they are caused by flying debris or unhealthy conditions that can result in “injury, illness or loss of necessary medical services.” The Harvard study found that interruptions in medical care were the primary cause for the high mortality rates in the months after the storm.
At the protest in New York, Mili Bonilla held a picture of her 85-year-old father, Jose (Pepe) Bonilla, with whom she would have regular phone conversations as he went to the supermarket or out for a walk.
After Hurricane Maria, Jose Bonilla, who lived in Toa Baja, Puerto Rico, began having trouble breathing. He was taken to a hospital, which ran out of oxygen. At another hospital, the generator providing electricity for his ventilator would shut off occasionally. The official cause of death on his death certificate was sepsis.
“In reality, his death was indirectly caused by the hurricane,” Mili Bonilla said. “The hospitals were not running as usual. These stories cannot be forgotten.”
Having an accurate death toll after a natural diaster helps determine the scope of the recovery effort, encouraging new resiliency efforts, while providing families closure and qualifying them for assistance, the Harvard researchers said in explaining their efforts.
Jordan Sanchez, who works with the disaster relief agency SBP, said he was worried about the future because Puerto Rico is still struggling with basic tasks. The new hurricane season began Friday.
Sanchez, who is Puerto Rican and has family members on the island, recently returned from his second trip there since the storm. He said families, especially in more rural areas, are still struggling to obtain power, healthy food and medical care. Normally, the relief effort would have already moved to the recovery and rebuilding phase.
“Even a strong storm could be devastating,” Sanchez said. “But we are a resilient people, so I have to remain optimistic.”
This article originally appeared in The New York Times.