The Urgent Need for Climate-Resilient Healthcare in Puerto Rico

Imagine this: It’s your first semester of college — just one month in — and you suddenly can’t reach your family or friends. A devastating storm has hit your home in Puerto Rico, and for days, you’re left in the dark. No texts. No calls. Just an endless loop of news headlines and the haunting weight of worst-case scenarios.

That was my reality during Hurricane Maria.

September 20th, 2017 is a date that now divides Puerto Rican history into Pre-Maria and Post-Maria. The storm’s winds tore through the island like nothing we’d ever seen — uprooting trees, peeling rooftops, and plunging the entire island into darkness. And I don’t just mean power outages — though those were everywhere — I mean the deep uncertainty that settled in. 

Roads were blocked, communications were cut, and hospitals were overwhelmed. For weeks, basic services — including healthcare — were barely functional. The damage was much more than physical; it laid bare the cracks in Puerto Rico’s healthcare system, especially in the face of natural disasters.

Hurricane Maria’s aftermath was a wake-up call. As climate change leads to more intense and frequent storms, we can no longer ignore how vulnerable our healthcare systems are, especially in places like Puerto Rico. In the months that followed, reports estimated that over 4,600 lives were lost, many due to delayed or disrupted medical care. 

Patients who relied on refrigerated medications like insulin were in crisis and those undergoing chemotherapy or radiation faced dangerous interruptions. These were not inevitable deaths. They were preventable — and that’s what makes it all so frustrating.

While aid eventually arrived, it wasn’t enough, and it wasn’t fast. The federal response revealed glaring gaps in emergency planning and an alarming disregard for specialized medical needs. For cancer care centers, continuous power and clean water aren’t luxuries or an afterthought — they’re lifelines. Yet these needs were not prioritized.

This experience drove our team at UCSF’s Greenhealth Lab to ask a crucial question: How prepared are Puerto Rico’s cancer care centers for the next major storm?

To find out, we surveyed radiation oncologists and medical physicists across the island. Our goal was to understand how their clinics have prepared for future disasters and where vulnerabilities remain. The results were both reassuring and concerning. While many clinics reported having backup generators and emergency protocols in place, some still lacked critical resources to ensure uninterrupted and adequate care. 

Providers also reported that patients bear the burden the most: limitations to physical access to clinics after disasters, damage to their homes, and inability to find childcare amid it all.  

Our findings make one thing clear: disaster preparedness for cancer care must go beyond backup power. We need comprehensive plans that include reliable communication, access to supplies, and clear protocols for patient transfers if treatment centers go offline. Strengthening these systems requires support, not just from clinics themselves, but from local governments, federal agencies, national organizations, and community partners.

Climate change isn’t coming — it’s already here and will continue to impact healthcare. We’ve seen it with hurricanes on the mainland US; we’ve seen it with severe heat waves and winter storms. And for patients with cancer, delays in care are a matter of life and death. Preparedness is essential, but it’s just the beginning. We need more research, more funding, and above all, more urgency and attention.

As a medical student born and raised in Puerto Rico, this is deeply personal to me. I’ve lived through the fear and the silence that follow a storm. I’ve seen the toll it takes — not just on infrastructure, but on people. Our hope is that this research helps spark lasting investment in climate-resilient healthcare systems. Because when disaster strikes, cancer care just can’t wait.