SAN JUAN, Puerto Rico (AP) — Disabled and elderly people were discharged from overwhelmed hospitals with bedsores that led to fatal infections. Medical oxygen ran out. People caught lung infections in sweltering private nursing homes and state facilities. Kidney patients got abbreviated treatments from dialysis centers that lacked generator fuel and fresh water, despite pleas for federal and local officials to treat them as a higher priority, according to patient advocates.

There was Ernesto Curiel, a diabetic who died of a heart attack after weeks of walking 10 flights twice a day to fetch insulin from his building’s only working refrigerator. Alejandro González Vázquez, 47 — unable to obtain his anti-psychotic medication, he committed suicide instead of boarding his flight back to the U.S. mainland. Juana Castro Rivera, 52, dead of leptospirosis, a disease transmitted by contaminated water. After several visits to a community clinic, she was diagnosed — too late — by a hospital in a neighboring municipality.

The joint project interviewed 204 families of the dead and reviewed accounts of 283 more to tell the stories of heretofore anonymous victims. Dozens more have contacted the Quartz, CPI and AP since their results were first reported.

Along with post-storm conditions, each death has a complex mix of causes that can include serious pre-existing conditions and individual decisions by patients, caregivers and doctors, making it difficult to definitively apportion blame in every case. But critics say many could have been saved by better preparation and emergency response.

“I was looking for help and no one came,” said Maria Gonzalez Munoz, who spent 30 days after the storm caring for her disabled sister in her blacked-out home.

Ramona Gonzalez, 59, died a month after the storm, from sepsis — caused, says her family, by an untreated bedsore.

The Gonzalez home is 3 miles (4.8 kilometers) from the convention center that served as headquarters for thousands of federal and local emergency responders for more than a month after the storm. Maria and her brother took Ramona to a hospital twice, and tried to get her aboard a Navy medical ship in San Juan harbor, but couldn’t save their ailing sister.

“No one was asking after us, no one from the government,” said Gonzalez Munoz, 66.

The hurricane’s true death toll has fueled debate since the first days of the storm, in large part because of the near-unique nature of the disaster.

The United States’ deadliest hurricanes have killed most of their victims with powerful winds and flooding in the hours and days immediately before and after landfall. The National Hurricane Center says that Katrina struck Louisiana and other states in 2005 it caused 1,500 direct deaths and 300 indirect ones from causes like heart attacks and failed medical equipment.

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