Many reports about Hurricane Maria that hit Puerto Rico in 2017 count about 3,000 lives lost as a result of the disaster.

Long-term struggles with poverty, lack of access to electricity and essential resources as a result of storm damage cause people to question that final number. And, some believe deaths today can still count against the storms’ impact.

The controversy has sparked some discussion around how to understand the impact a disaster like Hurricane Maria truly has, according to a recent article on Nature: International Journal of Science.

According to the article:

The vast number of deaths attributable to storms or earthquakes come afterwards, when broken health-care infrastructure can’t handle the ensuing spikes in disease and illness. But these deaths can be the most difficult to count. If someone has a heart attack while repairing their home and can’t get to the hospital because roads are blocked, is that person’s death the result of the hurricane? What happens when someone dies of leptospirosis, a bacterial disease spread in animal urine that contaminates water and soil, after moving debris?

“A death certificate might just say ‘cardiac arrest’. That’s it. How are you going to attribute that to a hurricane?” says Rei Hicks, a psychiatrist at the University of Massachusetts Medical School in Worcester). Many of the deaths from disasters and wars are indirect, she says, and so are challenging to attribute to a specific cause.

While poverty has been a long-term struggle in the U.S. territory, the devastation from Hurricane Maria has only created deeper pockets for poverty to linger, many news reports describing the struggle to restore its electricity and its additional negative toll on the area.

In a move to minimize future loss from an inevitable hurricane to the area, officials recently announced new plans to incorporate localized, solar powered energy systems across the island, according to a recent article on Forbes.

“With these fundamental changes proposed by PREPA, Puerto Rico can minimize the possibility of another disaster on the scale of Hurricane Maria, which had a death toll of almost 3,000 people. Puerto Rico has an opportunity to pioneer new grid technology that could improve lives for local people and be a model for the world to replicate.”