Every day, Mayibel Castro Santiago strives to protect herself from the blistering heat from the moment she wakes up until she goes to sleep. It’s no easy task — her small bed is out in the open, and during the day, she roams the scorching urban area of Ponce, a municipality on the South coast, that last month recorded heat indexes as high as 115 degrees Fahrenheit.

The 36-year-old woman rests near the entrance of what used to be a pharmacy in Ponce’s urban area, a structure abandoned two years ago. For the past year, she has been part of a community of other homeless people, whom she considers her family.

Mayibel is one of the 2,096 homeless individuals in Puerto Rico, one of the demographics most affected by the historic heat waves that have hit the island since last year due to climate change and global warming. According to the World Health Organization (WHO) and those interviewed for this investigation, homeless people are one of the most vulnerable populations to extreme temperatures and the most neglected by government authorities.

There is no approved plan or allocated funds to address the problem, although four Puerto Rican government agencies bear the primary responsibility for protecting this population — the Department of Family, the Department of Health, the Department of Housing, and the Multisectoral Council in Support of the Homeless Population, which is assigned to the Mental Health and Addiction Services Administration (ASSMCA, in Spanish), an investigation by the Centro de Periodismo Investigativo (CPI) revealed. The Committee of Experts and Advisors on Climate Change (CEACC) — created by the government — submitted proposals  in September 2023 to help vulnerable populations, including the homeless, cope with extreme heat, but none have been implemented.

The only thing in progress is a plan to address homelessness that ASSMCA began developing in January 2023 but did not finish. In April 2024, the task was outsourced to the stateside accounting and disaster consulting firm Horne, LLP, at $120,804 through two contracts. The contracts do not specify when the plan will be completed, but the second contract is valid until December 2024, before the new government administration takes office.

In the meantime, homeless individuals like Mayibel are left defenseless against the extreme heat. Compounding her situation is the fact that her hometown of Ponce is the second municipality with the highest number of homeless people on the island, according to the 2024 Puerto Rico Homeless Count.

In addition to her bed, Mayibel’s belongings are exposed to the elements, where the sun beats down mercilessly. She says she manages to protect herself from both the sun and the rain. She uses a plastic sheet to cover herself and her bed when it rains. Just steps from her sleeping area is her beach chair, under a tree where Mayibel seeks shelter from the heat.

As she shares her story, she tries to get her dog, Thunder, to greet her, but the animal refuses to come out from under the bed, where he’s hiding from the relentless sun.

The heat is stifling. The thermometer, which read 82 degrees Fahrenheit in Ponce’s urban core at 7 a.m., now shows 102 degrees Fahrenheit after midday. A heat advisory from the National Weather Service (NWS) is in effect. Castro Santiago continually wipes her face with a white cloth.

From January 1 to August 20, 2024, 30 excessive heat warnings and 80 heat advisories were issued in Puerto Rico, compared to 34 excessive heat warnings and 77 heat advisories for the same period last year.

“When it gets really hot, we mostly try to find a place where the shade and wind work in our favor. Since we’re at a pharmacy, it’s in the (former) drive-thru area,” says Mayibel. The temperature in that area is lower due to the direction of the wind and the shade the trees provide.

Heat waves can exacerbate chronic illnesses and cause heat-related health conditions like heat exhaustion, heatstroke, or cramps. Extreme heat can even be deadly. Among the populations most vulnerable to the effects of extreme heat, according to the WHO, are homeless people, pregnant women, infants and children, outdoor workers, and the elderly.

Heat stress claims more lives globally each day than any other climate-related cause of death, and many of these deaths occur outdoors, says the WHO.

Dr. Pablo Méndez Lázaro, associate professor in the Department of Environmental Health at the University of Puerto Rico’s Graduate School of Public Health and an expert on the subject, said heat-related deaths in Puerto Rico are underestimated because only direct causes like heatstroke are counted, whereas extreme heat actually contributes to mortality from other conditions like cardiovascular issues.

“Ultimately, the cause of death might be a cardiovascular problem, sure, but that cardiovascular issue was exacerbated by the climatic conditions,” he explained.

“What a heat episode does is push your system and body to the limit. And if you already have a pre-existing health condition, that condition will be exacerbated to the point where, unfortunately, it could lead to death,” he added.

This year, Mayibel has felt the effects of the heat so intensely that her aunt had to call an ambulance service to assist her on one of those extremely hot days, she said.

“I had to lie down because I felt really bad; my blood pressure was too low, and it was just so hot. No matter how much liquid I drank [I didn’t feel better], it was unbearable,” she expressed.

Dr. Andrés Calvo Díaz, an internist, said extreme heat can cause hypotension or low blood pressure due to dehydration. It can also increase the pulse, which can lead to arrhythmia.

“The heat makes us too tired, even to the point where we can’t sleep,” Mayibel pointed out.

The needs of the homeless population in Ponce are aggravated by the heat, said Brenda Pérez Acevedo, organizer of the Coordinated Entry System Project of the Coalition of Coalitions Pro Homeless People, a nonprofit organization that manages housing projects and services for the homeless.

“You can walk down the streets, there are no trees, you go through Paseo Atocha [in Ponce’s urban center], and the places are closed,” said Pérez Acevedo.

Nearly Two Years Working on a Plan That’s Still Not Ready

Extreme heat has already begun to affect the health of homeless people across the island, according to organizations working with this population that spoke with the CPI.

In addition to facing discrimination, which often affects their ability to find a place to get drinking water or shelter from the heat, homeless people are susceptible to dehydration and the worsening of illnesses, according to Dr. Calvo Díaz and Dr. Wanda Pacheco, who run the Alternative Integrated Clinic of the Coalition of Coalitions Pro Homeless People.

Despite homeless people being one of the most vulnerable populations to extreme heat, Puerto Rico does not have a protocol or plan to prevent or mitigate the impact of high temperatures on their health and well-being, even though these temperatures are expected to continue rising due to climate change, the CPI found.

According to Act 130 of 2007, the Multisectoral Council in Support of the Homeless Population has the ministerial duty to address the daily situations homeless people face. Still, in the more than eight years it has been assigned to ASSMCA, it has not produced any protocol to protect the homeless, according to Belinda Hill, executive director of Solo Por Hoy Inc., an organization that addresses homelessness in Puerto Rico.

The Council hasn’t even completed a plan to address homelessness, which has been in the works since 2022. After multiple meetings with nonprofit organizations, the Council contracted Horne LLP in April this year, a stateside accounting firm that, following Hurricane Katrina, which particularly affected Louisiana, diversified its services to enter the post-disaster assistance business. According to their pitch for creating the plan, their experience is based on assisting people whose homes were affected by disasters, but they do not specify expertise in working with populations who, for different reasons, are on the streets without a roof over their heads. Organizations in Puerto Rico that work with these populations consulted by the CPI do not recognize this expertise in Horne.

Since 2018, Horne LLP and Horne Federal LLC, owned by the same people, have generated $341.6 million in contracts with several Puerto Rican government agencies. Horne LLP manages millions of  federal disaster recovery funds, known as CDBG-DR, assigned to Puerto Rico’s Department of Housing.

Carmen Bonet, ASSMCA administrator, and Pedro Dedós, executive director of the Council, were unavailable for an interview with the CPI to answer questions about the draft plan, the reasons for contracting Horne for this task, and the specific measures they are implementing, if any, to protect the homeless population from the effects of climate change, particularly the heat. Instead, Bonet sent written statements confirming that Council members are reviewing a draft but did not provide details about its content or the measures taken so far.

“[In the plan] we focus on promoting public policy, as well as coordinating and collaborating with organizations, agencies, and municipalities that offer direct services to the homeless population, including during critical situations such as heat waves,” she said.

Regarding the measures, Bonet indicated in general terms that they have distributed water and provided information “to the homeless” on where they can find shelter, food, or showers in non-profit shelters.

Meanwhile, Housing Secretary William Rodríguez said his agency distributes housing vouchers to this population through the federal Rental Assistance Program, Continuum of Care PR-502. He did not specify how many homeless people have obtained housing under this program. He also said they had distributed packages with essential items to their homeless participants during the heatwave.

The Department of Health (DOH) also has no protocol for this population. Its spokesperson, Lisdián Acevedo, said the agency does not provide services to the homeless, and no official from that agency was available to discuss the issue.

Some initiatives that could benefit during heat waves, such as cooling centers, were included in the Mitigation, Adaptation, and Resilience Plan presented by CEACC to the Legislature in September 2023, but they are far from being implemented since the Plan was not evaluated in the last legislative session, and Senate President José Luis Dalmau deferred that responsibility to the legislators who will be elected next November.

Because of the high temperatures, several U.S. cities use existing public spaces such as libraries, community centers, and police stations as cooling centers. Cooling centers are public facilities with air conditioning where people and families can go to relieve the effects of extreme heat.

Governor Pedro Pierluisi said in writing that the Department of Health “closely monitors this issue and, if it results in an emergency, could establish recommendations to address it.” He added that the same agency evaluated the feasibility of the Committee’s Plan “to implement concrete public health actions, and address the population in the face of the heatwave,” but did not specify which actions or when they will be implemented.

Impact on Health

Francisco Rodríguez, executive president of the Coalition of Coalitions Pro Homeless People, assured that the extreme heat is affecting the health of the population they serve, especially among the elderly and those with physical or mental health conditions. He recounted that they’ve had to call emergency services to take people to the hospital because they are dehydrated, feeling dizzy, or very weak.

“That’s happening all over the island,” he said.

Meanwhile, Josué Maysonet Colón, executive director of La Fondita de Jesús, an NGO that serves the homeless, said that last year, they received participants who were dizzy and showing symptoms of heatstroke. This year, they worked with participants on prevention, providing them with hydration and avoiding emergencies.

Greater Impact on Health Due to Substance Use and Heat

Dr. Wanda Pacheco, who runs the Alternative Integrated Clinic of the Coalition of Coalitions Pro Homeless People, said the consequences of extreme heat in this population include dehydration and the worsening of ulcers, especially during the summer.

She added that other health conditions can worsen, such as colds, which can become complicated and lead to pneumonia due to dehydration.

“Regardless of their health status, this heat situation is dangerous for someone taking medications for mental health issues or medications for substance or even due to substance use. The heat exacerbates the situation,” Rodríguez said. Although not all homeless people use substances, those who do are at greater risk of health complications.

Dr. Andrés Calvo, an internist and addiction medicine specialist, said that substance use, including alcohol, nicotine, cannabis, cocaine, and opioids, puts a person at risk for medical complications, including dehydration. He added that a person’s metabolism can speed up, causing them to burn more calories than they consume through food, which stresses the body and uses more energy.

“People who are homeless or without shelter, without necessary facilities, often have lower food and water intake, which is something basic, and so they are exposed to those direct effects of substances at greater risk,” as the heat increases, he said.

As a result, they may suffer from heatstroke, he added.

Rodríguez also noted that studies show how heat affects mood and worsens conditions like depression and anxiety. According to the American Psychological Association, elevated temperatures can increase stress and anxiety, irritability, and aggressive behaviors, among other effects.

Independent Senator José Vargas Vidot, chairman of the Committee on Community Initiatives, Mental Health, and Addiction, and an expert in working with this population, said the effect of heat on people who use substances “is doubled.”

“There is typical dehydration with most substances. For example, benzodiazepines and opioids dry out the mucosa. The person needs more water and better temperature than anyone else because it’s typically an adverse secondary natural effect of these medications. On top of that, the person has no access to water,” he said.

Profile of Homeless People in Puerto Rico

The president of the Coalition of Coalitions Pro Homeless People said that in 2008, when his organization began working on a database of homeless people in Puerto Rico, 60% of the population were drug users. But that has changed, he said.

He indicated that most people now living on the streets are due to economic issues, such as job loss or evictions. This has been particularly evident in the past 10 years.

According to the latest 2024 Puerto Rico Homeless Count, the number of homeless persons is estimated at 2,096. Despite a slight reduction compared to the 2022 figures, the number of people living on the streets for the first time has increased, with 55.4% of those interviewed. The main reasons for being on the street for the first time are drug use (41.9%), family problems (34.3%), financial problems (16.9%), unemployment (15.9%), and mental health issues (14.1%).

No Plan for Homeless People

The executive president of the Coalition of Coalitions Pro Homeless People assured that the State has not taken this matter with the seriousness it deserves.

“There’s no plan that enables us to work on this in any way. So, the organizations are just doing what they can with the resources they have,” Rodríguez said.

He added that the situation for homeless people is complicated by public policy codes, “where they don’t want them in public places either” and “punish them” for being in such places. “So, they have nowhere to be, but they can’t be in the public place either. It’s a Catch-22.”

 Rodríguez said that last year the Coalition managed the approval of a proposal submitted to the Department of Housing under the CDBG-DR funds program to create a community resilience plan for homeless people. “We are working on that matter, including, of course, the heat issue, on how to prepare and how to change the scenario, and above all, the stigma in times of disaster.”

The director of La Fondita de Jesús agreed with Rodríguez that there is no government plan to help mitigate the effects of heat on homeless people or other vulnerable populations, such as bedridden elderly people.

“We’re not just talking about the heatwave, but at the same time, the electrical system isn’t functional. Most vulnerable communities now rely on pump systems, so if there’s no power, there’s no water, and then, at the same time, there’s extreme heat. It’s like this whole tornado mixed together,” said Maysonet Colón.

“For someone who lacks resources and already has a vulnerability in terms of health, in terms of money, all these factors gradually wear down the human being until, unfortunately, they die,” he added.

The director of La Fondita said that since April this year, the demand for health services offered to communities through their mobile unit has tripled.

He pointed out that since last year there has been a significant increase in the use of La Fondita’s facilities. He added that since April this year, the use of basic services there has doubled, including the use of showers, the search for water, and hygiene products. Moreover, homeless people who used to leave after receiving services are now staying in a common room they have in the courtyard.

“Specifically, regarding the heat issue, [homeless people] are staying longer under the fans, hydrating, and participating in various activities. They’re using the showers more,” said Maysonet Colón.

Dr. Pablo Méndez Lázaro, associate professor in the Department of Environmental Health at the University of Puerto Rico’s Graduate School of Public Health, assured that a protocol is needed to address the effects of heat on homeless people. “We’re being reactive, not proactive.”

The only formal proposal made in Puerto Rico to address this issue was done by the Committee of Experts and Advisors on Climate Change. The group of scientists proposed  establishing at least one cooling center per municipality.

Dr. Rafael Méndez Tejeda, climatologist and member of CEACC, said that first of all, the island’s electrical system must be improved “to  provide people a space where they could mitigate the heat.” Water sprinklers could be used, like those in Europe and amusement parks in Florida, he said.

He also said municipalities could establish cool places where people can go during peak heat hours.

“We would need to improve the energy system so that people can use air conditioning, and if they don’t have the possibility of air conditioning, they can go to a shopping mall. But if the Puerto Rico Electric Power Authority [PREPA] or LUMA (the private company) tells us: you can’t turn on the air conditioners because too much energy is consumed, then we have a serious problem,” he warned.

“Vulnerable people, obviously, as always, are the most affected,” lamented the climatologist.

What to Expect in the Coming Months?

August and September are expected to be even hotter, according to experts Ernesto Morales, meteorologist at the National Weather Service in San Juan, and Méndez Tejeda, professor at the University of Puerto Rico.

According to Méndez Tejeda, there could be many days with heat indexes as high as 110 degrees Fahrenheit.

“The reason for this is that if the water surrounding us doesn’t cool down, we won’t see a significant difference,” Morales explained.

He added that hurricanes help cool the ocean, as they push warm water away and bring up cooler water from the depths, a phenomenon known as upwelling.

“The problem is that we’ve been with these warm waters for so long that the depth of the warm waters has grown so much that, for example, when (the storm) Beryl passed (last June), we didn’t see any trace of cold water behind the upwelling areas. This means that not only is the surface water warm, but the deep waters are also warm. This is very concerning because it not only affects our temperatures but also marine life,” Morales said.

On the other hand, warm ocean water intensifies hurricanes, so this hurricane season is projected to be hyperactive, he said.

“Tropical cyclones feed and intensify on warm water. What’s needed for a system to intensify or organize is 80 degrees or more. And we’re talking about temperatures between Africa and Puerto Rico being 82 to 84 degrees,” he said.

“In shallower areas like La Parguera [in the southwest, in Lajas], we can see that water  temperatures are in the 90s [Fahrenheit] or more, so the energy is there. If we have the energy there, that could be affecting the intensification of these systems as they pass through our local waters,” he warned.

As the NWS forecasted, Puerto Rico experienced days of intense heat after Tropical Storm Ernesto in mid August.

Méndez Tejeda assured that another problem influencing extreme heat is Saharan dust.

“Saharan dust tends to decrease precipitation. And when it decreases precipitation, just like El Niño, there’s more heat, there are fewer storms forming, because when Saharan dust is introduced, it absorbs moisture,” the climatologist explained.

He mentioned that this dust can irritate the eyes and skin and cause respiratory problems. Medical experts say that people who spend a lot of time outdoors — like the homeless — are the most affected and recommend staying indoors when this weather condition is present.

In the meantime, Mayibel continues to fight for survival with the bottles of water she’s given, enduring the outdoor conditions during the hottest months of the year.