The hurricane-ravaged island is struggling with a variety of health problems caused by contaminated water, power outages, and a lack of medical supplies.

Hurricane Maria is long gone.

But Puerto Rico is still struggling to overcome a growing healthcare crisis.

So far, 48 deaths have been attributed to the hurricane since it made landfall on Sept. 20.

And that number appears to be growing almost by the day.

More than 100 people are still missing.

Plus, a bacterial infection caused by contaminated water is starting to spread across the island territory.

Damage to major infrastructure, including roads and electrical facilities, has also created new challenges as well.

Basic medical supplies are sorely needed.

“The initial and the ongoing need right now that has come up over and over again is the medications needed to manage chronic diseases like diabetes and hypertension,” said Danielle Butin, founder of the Afya Foundation, a New York-based organization that distributes surplus medical supplies and humanitarian provisions for healthcare crises around the world.

Afya has so far delivered more than 3,000 vials of insulin as part of 10 airlifts of medication and supplies to Puerto Rico valued at more than $1.7 million in the past weeks.

Outside the capital and metropolitan center of San Juan, access to healthcare and the ability to deliver supplies has become increasingly difficult.

“There has been really, really poor coordination and distribution of medical supplies and medical care in the rural areas,” Butin told Healthline.

She said their next focus will be to help supply nursing homes with basic supplies, including diapers for elderly and frail patients.

Elderly patients and those with chronic illnesses that require ongoing treatment, such as dialysis, are particularly at risk because of the hurricane’s damage to Puerto Rico’s electrical grid.

In Florida, 14 elderly nursing home patients died after their care center lost power when Hurricane Irma hit the state in early September.

In Puerto Rico, there’s an urgency to get adequate generators supplied with fuel to keep hospitals up and running.

“There are people who require generators for life-sustaining measures,” said Butin. “They require electricity to run medical machinery and there aren’t enough generators operating. There aren’t enough generators to distribute for what’s needed at this point.”

An estimated 84 percent of Puerto Rico is still without power.

Reuters reported that in some instances, fuel for hospital generators has been delivered by armed guards to protect against looting.

Fresh water is also an ongoing problem that has led to an increase in bacterial infections. Forty percent of the population is believed to still be without running water.

Leptospirosis, a disease that can be spread by animal urine and flood waters is being investigated as the cause of four deaths so far.

The disease can cause kidney damage, meningitis, and respiratory disorders.

“People are drinking out of creeks that are incredibly problematic. Water access and treated waters is a huge issue,” said Butin.

Drinking from a stream is believed to have caused at least one of the cases of leptospirosis.

The spread of contaminated water either through flooding or from drinking from a polluted source also increases the risk of other serious diseases, including cholera and hepatitis.

Conjunctivitis (pink eye), caused by fecal matter, has seen an uptick on the island.

“Conjunctivitis is everywhere, so now they are in need of medicated eye drops,” said Butin.

Beyond the acute and immediate medical needs on the island, there’s also a specter of despair brought on by the near constant back and forth between the island’s leadership and President Trump.

The president’s public comments have done little to calm the fears of those in Puerto Rico.

His statement last Thursday that federal workers may leave the island soon added to those worries.

“They are really scared there,” said Butin. “People are worried about where they are going to get their medication. People are worried about getting sick.”