Race and Racism as Structural Determinants for Emergency and Recovery Response in the Aftermath of Hurricanes Irma and Maria in Puerto Rico.

To explore the role of race and racism in emergency response and recovery in the aftermath of hurricanes in Puerto Rico (PR). Sixteen semistructured qualitative interviews were conducted between March and April 2018 with community members who had an active role in the process of response and relief efforts. Among participants, eight were from PR, and eight were of Puerto Rican descent living in the continental United States. Narrative text from interviews was analyzed using grounded theory approach and narrative analysis techniques. Participants were adult men and women from different municipalities in PR and diverse regions of the continental United States and with diverse professional and economic backgrounds. In the analysis of the interviews, "fitting the box" of race, race in emergency and recovery response, and community philanthropy emerged across narratives as frequent and as illustrative of the issues of race/racism and response to natural disasters in PR. Participants shared a perception that the combination of disasters, including natural disasters and historic political mismanagement, is the cause of the precarious conditions in PR in the aftermath of the hurricanes. Race was perceived as a problematic construct in the understanding of Puerto Rican identities. Racism was contextualized as part of the complicated relationship between PR and the United States and as an obstacle for adequate emergency response. Systemic racism was perceived as a barrier to emergency and recovery response in the aftermath of natural disasters. Structural changes are required to reduce vulnerability and health inequities in PR.