It wasn't until Tuesday, when experts from the George Washington University, commissioned by the Puerco Rican government, that it was officially acknowledged the death toll had been much higher, counting those who died between September 2017 and February 2018 as a effect of the infrastructure damage, poor health care, lack of basic services and power cuts. That number has been almost cut in half since June 30, before the lawsuit was filed, when there were 617 families enrolled, Castillo Gomez said. "Yes, in hindsight, things could have been handled differently".
There are 1,038 families in 27 states and Puerto Rico. That's nearly twice the government's previous estimate.
The team found that lack of communication, well established guidelines and lack of training for physicians on how to certify deaths in disasters, resulted in a limited number of deaths being identified as hurricane related.
The latter will also make up the theme for the International Day for Disaster Risk Reduction 2018, marked on 13 October.
She said it is creating a hardship for families who are still trying to get closure.
"This is representative of this administration's priorities on how they respond to disasters", added Lycia Ora Bannan. That does not include indirect deaths of the sort the George Washington researchers counted in Puerto Rico. It had become impossible for the people on the island to contact loved ones and get help for weeks after the storm.
"We have put billions and billions of dollars into Puerto Rico, and it was a tough one", Trump said Wednesday.
Yet many remain outraged at both the local and federal governments.
Trump also mentioned that aid to Puerto Rico was made more hard due to it being an island and praised the work of the Federal Emergency Management Agency.
The government's initial number was for those killed directly by the hurricane, crushed by collapsing buildings, drowned or hit by flying debris.
Hillman said he was forced to issue the ruling because the evacuees weren't likely to succeed on the merits of their case.
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All jurisdictions, not only Puerto Rico and other parts of the US but also globally, should develop methods to rapidly assess total excess mortality after natural disasters and to provide that information to the public. Power on Puerto Rico was only restored last month, according to the New York Times. It increased drastically to 1,400 earlier this year. "However, the Court cannot order that Defendants to do that which in a humanitarian and caring world should be done - it can only order the Defendants to do that which the law requires", Hillman wrote.
"It is anger, it is frustrating", she said. "I don't wish that on anyone".
The Puerto Rican government's longstanding official death toll from Maria had been 64.
The first phase of the study cost $305,000.
The researchers found that the risk of death was 45 percent higher for those living in impoverished communities, and that men over 65 saw a continuous elevated risk of death.
The report found an estimated 2,975 deaths could be attributed directly or indirectly to Maria, the most powerful storm to hit the Caribbean island in nearly a century, from the time it struck in September 2017 to mid-February this year.
However, they did not share details of their methodology, saying those will be released if the study is published in a scientific journal.
"I would say this is a study that can provide everybody a sense of security that, yes, this is a number that you can use as a reference for the future", said Carlos Santos-Burgoa, principal investigator and professor of global health at GW's school of public health. "We used very rigorous methodology".
The report is entitled, "Ascertainment of the Estimated Excess Mortality from Hurricane Maria in Puerto Rico". Maria was a Category 4 with 154 miles per hour winds.
John Mutter, a professor at Columbia University who researches disaster management, said death certificates are "critical" to determining what is attributable to the hurricane.
"The responsibility for adjudicating the cause of deaths rested with the doctors", Mr Rossello said.