Infections, sewage and mosquito-borne illness outlast hurricanes Portrait of Eduardo Cuevas Eduardo Cuevas

Since Hurricane Helene, it’s been a colossal undertaking to get clean water at Asheville’s Mission Hospital, the only designated trauma center in western North Carolina.

Hospitals like Mission need potable water for staff to sanitize equipment, clean wounds and simply wash their hands with soap. Other facilities − such as Asheville’s Planned Parenthood clinic and local birthing centers − were forced to cut key health services because they didn’t have running water.

The surrounding community has been battling an array of public health challenges in the aftermath of the historic deluge in late September, including residents’ risk of being exposed to sewage, toxic industrial waste and mosquito-borne illnesses.

However, experts say the lack of potable water is the area’s biggest concern. Without it, residents are limited in their access to nutrition and sanitation and more likely to be exposed to disease and infections, according to Dr. Daniel Kuritzkes, chief of Brigham and Women’s Hospital’s infectious diseases division, in Boston.

Overwhelmed hospitals are struggling to treat new and existing patients as they cart in truckloads of water and dig new wells.

“You’re going to have patients that have short-term injuries that end up being chronic issues,” Marquita Lyons-Smith, director of North Carolina Central University’s nursing program, told USA TODAY. “Because they were not taken care of immediately, given the attention they deserve.”

Before the storm, many rural communities were already facing hospitals shuttering, putting care farther from reach, she said.

Contaminated water, infections abound

Each day, Mission Hospital brings more than 30 trucks to pump more than 200,000 gallons of water into the facility, according to hospital spokesperson Nancy Lindell. The facility is considering drilling additional wells so its HVAC units can continue to regulate indoor temperatures.

The hospital and region are stymied because water pipes are damaged, and sewage and chemical toxins have contaminated the water supply, making residents vulnerable to diarrheal diseases, fever, dehydration and other ailments.

Other dangers lurk. Mold from floodwaters can flourish, triggering respiratory issues. Standing water fosters mosquito breeding, Kuritzkes said, which increases the risk of dengue or West Nile virus. North and South America have seen record levels of people infected with dengue in the past year, sparking concerns for increased transmission as warming climates push disease-carrying mosquitoes into more areas across the U.S.

‘The tip of the iceberg’

Along with the threat of infectious diseases, hospitals in North Carolina are also busy treating injuries that happened during the storms.

This is also the case in central Florida following Hurricane Milton, which left Gulf Coast residents coping with injuries that happened during the flooding, powerful winds and tornadoes. Amid power outages in both storm-battered regions, people turned on generators, which can trigger carbon monoxide poisoning stored in an enclosed setting.

After the waters recede, people’s preexisting chronic health conditions such as heart disease and diabetes can worsen because people don’t have access to medication or treatment. Sixty percent of Americans have at least one chronic condition, and more than 40% have multiple chronic conditions, according to the CDC.

In the aftermath of a storm, the death toll can rise because people can’t access blood pressure medication or dialysis, according to Kuritzkes, of Brigham and Women’s Hospital. People with disabilities also face challenges accessing help in emergencies.

Over 230 people died in the wake of Helene, most in North Carolina, and 17 due to the impact of Milton, in Florida.

“These numbers, they’re very devastating, but also relatively low,” Jeffrey Schlegelmilch, director of Columbia Climate School’s National Center for Disaster Preparedness, told USA TODAY. “We can’t forget that, actually, that’s really just the tip of the iceberg.”

Hotter ocean waters caused by greenhouse gas emissions make storms stronger and they can develop more swiftly into hurricanes. This gives residents less time to prepare or evacuate, akin to what happened during Helene and Milton.

Public health officials need to learn to react more quickly, even when the risk of a hurricane or flood doesn’t seem significant or imminent at the moment, said Dr. Giridhar Mallya, a senior policy officer at the Robert Wood Johnson Foundation.

Severe weather events are becoming more common, he said. “Public health has to be part of the planning and response.”