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Healthcare Ready Hurricane Ian Situation Report #5

High Level Situation Summary Highlights Emergency Declarations and Measures Critical Infrastructure Impacts Access and Reentry Healthcare Response Updates and Needs Public Health Impacts Supply Chain Resource Staging Emergency Prescription Refills Evacuations and Curfews Sheltering
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Hurricane Ian Situation Report #5

This report provides an assessment of the impacts to healthcare and public health due to Hurricane Ian.

Note: Green text indicates new or updated content in this report compared to the previous report.

Healthcare Ready's Posture

Healthcare Ready is ENGAGED for the response to Hurricane Ian. We are closely tracking potential impacts to healthcare infrastructure and supply chain, and will share information frequently via situation reports and Twitter, Facebook, and LinkedIn. Our pharmacy operating status map Rx Open will be updated daily for pharmacies in Florida, Georgia, South Carolina, North Carolina, and Puerto Rico.

High-Level Situation Summary

Since making landfall on 9/28, Hurricane Ian has caused catastrophic damage across Florida. Several hundred healthcare facilities have been impacted and many remain closed, though some facilities of all types – including pharmacies, clinics, hospitals, and dialysis centers – have started to resume operations as damage assessments conclude. Transportation impacts, including damage to connections (causeways, bridges) to several barrier island communities (Sanibel Island, Pine Island), have resulted in those communities being completely cut off to road travel.
 
Ian made a second landfall as a Category 1 hurricane near Georgetown, South Carolina at 2:05pm EDT on 9/30. The storm has caused further damage, though power outages in South Carolina have already decreased greatly since their peak, which may suggest more limited damages overall. Coastal South Carolina is the most impacted area in the state. Central North Carolina and central Virginia also saw some impacts. Georgia has largely been unaffected by the storm.   

Highlights

  • As of 1:30pm EDT on 10/1, nearly 1.2 million Florida customers have power outages. This is a decrease of about 700,000 outages since 9/30.
  • More than 140,000 residents in South Carolina are experiencing power outages. As of 1:30pm EDT on 10/1, more than 200,000 customers were without power in North Carolina. As of 1:30pm EDT on 10/1, more than 60,000 customers are without power in Virginia and more than 20,000 customers in South Carolina.
  • Lee County, Florida, was without running water on Friday (9/30) after its water system was severely damaged from hurricane Ian. Florida Gov. Ron DeSantis and state officials said restoring water service to the area was a top priority for responders. The outage is impacting a population of about 760,000 residents, who are now reliant on bottled water distribution sites. The outage also resulted in the evacuation of nine hospitals.
  • Many Florida residents have begun to return home from shelters, reducing the population in shelters from 33,000 on 9/30 to just over 10,000 on 10/1.
  • The Seminole Tribe of Florida’s request for a Major Disaster Declaration was approved on 9/30.
  • As of 10/1, all major ports have reopened in Florida.
  • All but one major Florida airport have reopened. Southwest Florida International Airport (RSW) will remain closed until further notice pending water and power restoration. The airport continues to serve emergency personnel and humanitarian flights.

Assessment of Healthcare and Logistics Impacts

Emergency Declarations and Measures

Critical Infrastructure Impacts

  • Power
  • Fuel
    • No updates from 9/30.
    • As of 9/30, 11% of Florida’s gas stations are without fuel or are not operational due to impact of the hurricane.
    • Those looking for fuel and gas can use this link, Gas Buddy, to search for open stations and providers.
    • The Interior Department’s Bureau of Safety and Environmental Enforcement has suspended around 190,000 barrels of oil production (equal to around 2% of total US oil production) in the Gulf of Mexico as Ian headed to Tampa and Florida.
    • As of 9/28, Chevron Corp (CVX.N) removed staff from two offshore Gulf of Mexico platforms, however Occidental Petroleum Corp (OXY.N) and Hess Corp (HES.N) have taken precautions ahead of the storm’s arrival and are implementing storm procedures. This may impact fuel resources getting sent to other areas of the country and could impact medical and other types of manufacturing.
    • Florida officials are also identifying opportunities to safely store fuel and transport equipment as the storm passes. Port impacts pose significant risk to fuel supply for central Florida, and cascading impacts on the movement of goods.
  • Water
    • As of 10/1, 42 drinking water treatment plants are non-operational; 45 plants partially operational; 700 fully operational; 98 (+51) boiled water notices are in effect
    • Lee County, Florida was without running water on Friday (9/30) after its water system was severely damaged from a direct hit from hurricane Ian. Florida Gov. Ron DeSantis and state officials said restoring water service to the area was a top priority for responders. The outage is impacting a population of about 760,000 residents, who are now reliant on bottled water distribution sites.
    • As of 10/1, boil water notices are in effect in at least 21 counties throughout Florida.
    • On Friday (9/30), FEMA sent 1.6 million liters of water to Florida and promised that another 6.6 million liters were on the way.
    • The US Army Corps of Engineers are meeting with county officials, noting that work crews are using water trucks to pressurize critical facilities to locate and repair leaks.
  • Communications
    • Florida
      • According to the Federal Communications Commission (FCC): 
        • As of 12pm EDT 10/1, FCC reports: 4.1% of cell sites are down. 11 (-14) cell sites are down due to damage, 271 (+91) are due to transport, and 469 (-282) are due to power outages. 423 cell sites are running on back-up power.
        • All 911 calls are being answered but some Public Safety Answering Point (PSAP) are being rerouted due to power outages.
      • As of 9/30, 5 TV stations are reported as being out of service, 15 FM stations are reported as being out of service, and 6 AM stations are reported as being out of service.
      • The (FCC) may grant Special Temporary Authority (STA) to permit immediate or temporary operation of certain radio facilities during emergencies or other urgent conditions, as well as waivers to support emergency communications and service restoration.
      • Comcast has opened Xfinity WiFi hotspots in Central, North, Southwest, and Panhandle of Florida for Xfinity customers, and non-customers, to remain in contact during and after the storm.
      • AT&T has waived talk, text, and data overage charges for Postpaid and Prepaid customers with billing addresses in the Florida zip codes (828) through October 28, 2022, to facilitate customer access to communications before, during, and after major events.
  • Transportation
    • Road Closures and Travel Updates
      • Florida
        • Florida 511 will be providing real-time traffic conditions and incident information.
        • There are dozens of road closures across central Florida along the path the storm took from coastal Fort Myers/Cape Coral area northeast to Daytona Beach.
        • Closures are concentrated in Fort Myers, Port Charlotte, Orlando, and Daytona Beach.
        • Jacksonville, Tampa, and St. Petersburg road closures reported on 9/30 have largely reopened.  
        • The SR-78 / Pine Island at Matlacha Draw Bridge, which connects Pine Island to Ft. Myers, remains closed in both directions as of 7:05am EDT 10/1. This is the only road into Pine Island, meaning its residents are cut off from assistance and rescues can only be conducted by water or air.
        • Hurricane Ian destroyed a section of the Sanibel Causeway connecting Sanibel Island and Captiva to mainland Florida, cutting off the only access to the barrier island where roughly 6,300 residents reside. The Sanibel Causeway bridge remains closed as of 7:05am EDT 10/1. With the bridge compromised, Sanibel-Captiva rescues can only be conducted by water or air.
      • South Carolina
        • The South Carolina Department of Transportation provides live updates on South Carolina 511. Users can view alerts from the National Weather Service as well as evacuation resources.
        • Several news outlets are reporting road closures due to flooding, including areas of downtown Charleston, West Ashley, Summerville, North Charleston, Georgetown, James Island, and Johns Island.
      • North Carolina
        • As of 10:00am EDT 10/1, there are 18 active incidents on main roads and 97 incidents on secondary roads. Incidents (road closures, lane closures, and congestion) are concentrated throughout the middle of the state along the path Ian took.
        • Randolph, Guilford, and Stokes counties have the most closures defined as “major incidents” and may be more difficult to access.
        • DriveNC.gov provides the latest travel information, including a map showing how Ian is impacting travel in North Carolina.
        • North Carolina’s 511 Information Line is available to motorists throughout the state.
    • Airports 
      • Florida
        • According to the Federal Aviation Administration’s airport status map, airports are largely operational in Florida. Daytona Beach International (DAB) has reopened as of 10/1.
          • Southwest Florida International Airport (RSW) in Fort Myers is the remaining major airport closure as of 10/1. RSW will remain closed until further notice pending water and power restoration. The airport continues to serve emergency personnel and humanitarian flights. The FAA states RSW is expected to reopen on 10/7.
          • As of 9/29, North Perry Airport (HWO) in Hollywood Broward County remains closed due to tornado damage. No new updates as of 10/1.
      • Other states
        • All major airports in North Carolina and South Carolina are open as of 10/1.
    • Port status
    • Rail
      • Freight activities have slowed (increasing delays) or temporarily stop operations in Florida.
      • As of 10/1, FEMA reports that nine railways have closed with numerous Amtrak and Northern schedule cancellations and changes.
      • As of 10/1, SunRail service remains suspended.

Access and Reentry

  • Florida
    • Florida’s access and re-entry plans and policies are managed by local officials, working closely with Florida’s Division of Emergency Management. During a disaster, private sector companies should coordinate with the Division of Emergency Management, in addition to local health departments and local emergency managers to assess whether they are authorized to enter an impacted area, only after it has been deemed safe enough to do so.
    • Individuals who wish to enter the disaster area must have the following on hand:
      • Valid government issued ID (driver’s license, passport)
      • Proof of employment (employer credentials, document on company letterhead)
      • Demonstrated need to enter the area (work order, inventory list, employer authorization)
      • Note, DHS CISA’s Access Coordination Letter is not an acceptable document to enter any disaster areas in Florida.
  • North Carolina
    • North Carolina requires pre-registration of vendors who provide critical services and goods before they attempt to enter disaster areas. These vendors must apply for a Certificate of Post Disaster Re-entry to be able to enter areas impacted by disasters. Information on applying for this certificate can be found at this North Carolina Business Emergency Operations Center site. Final decisions about entry/re-entry are still under the authority of local governments.
  • South Carolina
    • South Carolina requires business to register for post-disaster reentry certification before they attempt to enter impacted areas. Business can register for the program with the SC Emergency Management Division and SC Department of Commerce. Final decisions about entry/re-entry are still under the authority of local governments.

Healthcare Response Updates and Needs

  • Healthcare and Adjacent Facilities
    • As of 10/1, FEMA reports 145 healthcare facilities impacted by Ian. FEMA reports two hospitals and two nursing homes have been fully evacuated.
    • As of 10/1, nine Lee County hospitals are in the process of evacuation due to water availability issues, though water has begun to be restored at some facilities. Lee County hospitals that evacuated due to water issues include:
      • Lee Health’s Gulf Coast Medical Center and HealthPark Medical Center, which  began evacuating on 9/29.
        • All Lee Health system emergency rooms remain open.
        • As of 09/30 at 6pm, Lee Health’s pharmacy as well as other Lee health pharmacies are open 24 hours. Lee Telehealth is free and operational 24 hours and Dispatch health has resumed treating people at home. 
    • As of Saturday 10/01, these VA Hospitals remain closed:
      • Naples VA Clinic
      • Lee County VA Clinic
      • Port Charlotte VA Clinic
      • Daytona Beach VA Clinic
    • ShorePoint Health Port Charlotte reopened on 9/29 for medical emergencies. As of 9/29, it was the only operational ER in Charlotte County.
    • As of 9/30 NCH Downtown Baker Hospital and all other NCH locations remain on lockdown , but are accepting emergency room patients.
    • As of 9/29, Tampa General Hospital’s emergency room is open and caring for patients. All Ambulatory locations remain closed and elective surgeries and procedures are cancelled.
    • Other closures and evacuations:
      • HCA Florida Pasadena in Pinellas County evacuated about 40 patients on Monday 9/26. HCA Florida South Tampa Hospital and HCA Florida West Tampa Hospital also reported evacuations.
      • On 9/29, Sarasota Memorial Hospital in North Point closed its emergency room. However, as of 9/30, Sarasota Memorial Healthcare System has reopened their urgent care centers.
      • On 9/28, Kindred Hospital Bay Area – Tampa and Kindred Hospital Bay Area – St. Petersburg announced they safely evacuated all patients to other facilities.
      • On 9/28, Windmoor Healthcare of Clearwater reported it safely evacuated patients and staff.
      • As of 9/27, Encompass Health Rehabilitation Hospital of Cape Coral has evacuated all patients and staff to another Encompass Health area hospital.
      • HCA Florida Fawcett Hospital in Port Charlotte was severely damaged during the hurricane, patients in the ICU were affected by flood waters entering their rooms.
      • Advent Health locations in Central Florida remain closed and hospice care facilities have paused home visits and admissions. Elective surgeries are postponed. AdventHealth North Pinellas also evacuated patients.
    • As of 9/28 North Plant Bay Hospital operated by BayCare is closed. All urgent cares operated by the company are also closed.
  • Emergency Medical Services
  • Pharmacy
    • Rx Open is activated for Georgia, Florida, South Carolina, and North Carolina. It was last updated on 10/1 at 2:00pm EDT and is showing 377 pharmacy closures across the impacted states.
    • Please see the table outlining pharmacy statuses per state: 
    • The following counties are reporting fewer than 50% of pharmacies as open:
      • Florida: 22 counties (+2 from 9/30): Baker, Brevard, Broward, Charlotte, Citrus, Collier, DeSoto, Flagler, Gilchrist, Glades, Hardee, Hillsborough, Lake, Lee, Manatee, Miami-Dade, Orange, Osceloa, Pinellas, Sarasota, Seminole and Volusia
      • Georgia: 38 counties (+22 from 9/30): Atkinson, Baker, Bibb, Brantley, Brooks, Butts, Calhoun, Chattahoochee, Clay, Clayton, Cobb, Crawford, Decatur, DeKalb, Dooly, Echols, Fayette, Fulton, Glascock, Irwin, Jefferson, Liberty, Long, Lowndes, Macon, Meriwether, Oglethorpe, Pickens, Putnam, Quitman, Richmond, Talbot, Taliaferro, Turner, Ware, Warren, Wayne and Wilkinson counties.
        • Note, these counties are showing less than 50% pharmacies operational due to an unusually high output of “Pharmacies not Participating”. This is likely due to adjusted weekend hours as well as storm impacts.
      • South Carolina: Calhoun, Charleston, Cherokee, Lee, Marlboror and Saluda counties.
      • North Carolina: Bertie, Camden, Hyde, Vance and Warren counties.
    • Pharmacy deliveries via Express Scripts may arrive late.
  • Dialysis
    • As of 10/1, many dialysis facilities impacted by Ian have reopened, though closures remain in Florida. Most closed facilities plan to reopen by Monday, 10/3.
    • In Florida, several facilities are on generator power and/or connected to water tankers. Damage has been reported at some facilities, but overall damage is minimal.
    • See Kidney Community Emergency Response (KCER’s) Hurricane Ian webpage to share information with the dialysis community. The page includes patient helpline numbers and contacts for End Stage Renal Disease Networks supporting Florida:

Public Health Impacts

  • Infectious illnesses
    • With people entering shelters due to the hurricane, there is a higher potential for COVID-19 and other infectious and vector borne diseases to spread without the appropriate precautions and protective measures.
    • As of 9/30, CDC reports 11,825 total COVID cases, 256 new hospital admissions, and 53 deaths in the past seven days in Florida.
    • As of 10/1, there are 2,529 Monkeypox cases in Florida.
  • Mental health
    • The Hurricane Ian disaster recovery hotline is available for mental health needs, disability services, military and veteran assistance, etc.
    • Individuals may call or text 211 to be connected with help for physical and mental health needs and assistance in the aftermath of Hurricane Ian.
    • The SAMSHA Disaster Distress Helpline, 1-800-985-5990, is open 24/7 to provide immediate crisis counseling for people who are experiencing emotional distress. The Helpline is toll-free, multilingual, and confidential and is available to all residents in the United States and its territories. Individuals may call or text 1-800-985-5990 to connect with a trained crisis counselor.
      • Royal Park Hospital Patients experiencing behavioral health crisis are encouraged to call the National Suicide and Crisis hotline at 988.

Supply Chain

  • Manufacturing
    • Manufacturers in Florida have not reported any major impacts. There are no expected impacts to Georgia, South Carolina, and North Carolina supply chain.
  • Distribution
    • Localized healthcare supply chain disruptions are likely, however damage to distribution centers has been minor.
    • As of 9/30, retailers, such as Amazon.com Inc., have about 10 fulfillment centers in Florida and have paused operations at these sites. Walmart Inc. (WMT.N) and Sam Club have closed at least 100 stores and Target Corp (TGT.N) temporarily closed stores. Costco Wholesale Corp closed 9 stores in Florida.
    • Many of the medical product distributors as well as third party logistics providers have operations and/or distribution centers in Florida. We will be closely tracking any impacts to facilities or centers to determine any downstream supply chain impacts.

Resource Staging

  • General resource staging
    • As of 9/29, FEMA teams have delivered 1.1 million meals and 1.5 million liters of water to impacted areas. More supplies are expected to follow once conditions are deemed safe for transport. FEMA is currently procuring an additional 6 million liters of water and 5.5. million meals.
      • As of 9/28, FEMA has been preparing and staging supplies in strategic locations in Alabama and Florida. One location is Maxwell Airforce Base in Alabama. Supplies being staged at Maxwell Airforce Base include four Mobile Communications Operation Vehicles, 3.5 million liters of water and 3.6 million meals. Supplies in Alabama include more than a million liters of water, more than 480,000 meals and more than 7,200 cots.
    • As of 9/29, US Department of Health and Human Services deployed a National Disaster Medical System (DMAT) of 38 personnel to Miami and two other teams to Robins Air Force Base in Georgia. Additionally, two health and medical task forces and four pharmacists were deployed to Atlanta. Additional DMAT teams are on standby if needed.
  • Florida
    • Florida Department of Emergency Management (FDEM) has six active fuel depots and is staging an additional four fuel depots today throughout Central and Southwest Florida to ensure first responders have the fuel they need to conduct search and rescue operations.
    • FDEM is deploying several hundred shelter support staff to address staffing needs in counties that have opened their Special Needs hurricane shelters. Currently, more than 200 public shelters are open and available to impacted residents, with more than 50 of these being Special Needs Shelters.
    • FDEM has received more than 2,000 resource requests for Hurricane Ian and fulfilled. Over 1,700 of these requests are currently being processed and are either en route or being mobilized. This includes the coordination of resources such as: trucks of food and water, generators, and water pumps.
    • FDEM is deploying the following resources for distribution to impacted areas:
      • More than 4,000 gallons of diesel to Lee County to power water plants that provide water to nearby hospitals.
      • Drone teams to assess flooded areas.
      • 500 traffic barrels to Charlotte County to safely modify traffic patterns.
      • More than 400 bottles of oxygen to Charlotte County.
      • 255 ambulances.
      • 200 trucks of food, water, and ice.
      • 200 large generators.
      • 2 full service mechanical shops.
      • 500,000 tarps.
      • 375 kits for parents of infants and toddlers with critical supplies that will last for 10 days each.
      • Four mobile triage units to Miami-Dade County.
      • Five truckloads of blankets and five truckloads of cots to support displaced residents.
      • FDEM is currently coordinating the provision of meals for first responders staged in Orange County.
    • FDEM has over 3.5 million meals and over 1.8 million gallons of bottled water in preparation for distribution to impacted areas.
    • FDEM is in constant communication with all 67 county emergency management offices and state agencies to coordinate protective actions and needed resources ahead of potential storm impacts.
    • FDEM has activated the State Assistance Information Line (SAIL) to provide an additional resource for Floridians to receive up-to-date information regarding Hurricane Ian. Residents and visitors can call this toll-free hotline at 1-800-342-3557.
    • As of 9/29, Florida Emergency Operation Center (EOC) is fully activated.
      • Incident Management Teams are in Tallahassee, Miami, and Atlanta. Mobile Emergency Response Support teams are present in Tallahassee and Orlando, with support teams located in Alabama and Georgia.
      • More than 2,000 personnel are supporting the response throughout the Southeast with more than 3,200 reservist personnel and more than 7,500 Surge Capacity Force members standing by for deployment. FEMA is establishing a personnel mobilization center to expedite deployments when critical.
    • Georgia
      • As of 9/29, the Georgia EOC has fully activated.
    • South Carolina
      • As of 9/30, the South Carolina EOC is fully activated.
    • North Carolina
      • As of 9/30, Governor Cooper has assured that crews in North Carolina have checked necessary equipment to ensure that we already, we have had more than 2200 employees statewide help us prepare this week for this event. We have about 1500 chainsaws, 11,000 barricades, emergency signs and ample fuel supply to respond. We have also specialized equipment ready to clear debris in about 1400 trucks, 400 backhoes and loaders and more than 200 motor graders ready to respond. 

Emergency Prescription Refills

  • Florida
    • As of 9/24, early prescription refills are permitted under State of Emergency. All health insurers, managed care organizations, and other entities licensed by the Office of Insurance Regulation and provide prescription medication coverage as part of a policy or contract will waive time restrictions on prescription medication refills.
    • Overarching Florida disaster regulation states that you can obtain a 30-day refill of your prescription medication – even if you have just refilled it – if you reside in a county that:
      • Is under a hurricane warning issued by the National Weather Service;
      • Is under a state of emergency executive order declared by the Governor; or
      • Has activated its emergency operations center/emergency management plan.
    • Opioids are considered a controlled substance, and therefore excluded from emergency prescription refill laws.
    • About 13% of Florida’s population is uninsured. Emergency Prescription Assistance Program (EPAP) is the federal program that provides medication coverage for uninsured patients, but the program has not yet been activated.
    • Centers for Medicare & Medicaid Services (CMS) implemented 1812 Waiver and 1135 Waiver in response to the Public Health Emergency (PHE) declaration. These waivers and modifications are intended to ensure individual pharmaceutical and medical needs are met during emergency and disaster situations.
    • As of 9/29, individuals that live in one of the 67 impacted counties who have Blue Cross Blue Shield of Florida (Florida Blue and Truli) memberships can access early prescription refills for maintenance medications through 10/24/2022.
      • People impacted can receive a 30-day supply.
      • Teledoc, the virtual healthcare system is available for $0 cost to those impacted by Hurricane Ian.
      • This hotline number, 855-225-5032, will help to reach doctors 24/7 through this network for basic care and prescriptions and prescription refills that are not controlled substances.
    • As of 9/29, Humana Healthy Horizons™ in Florida will provide special accommodations for prescription access until the PHE declaration has ended, and or, 30 days has passed since the initial event.
    • As of 9/28, Cigna has lifted certain medical and benefit pharmacy restrictions.
    • As of 9/28, Molina Healthcare of Florida is suspending all prior authorization requirements for prescription refills until the state of emergency is lifted.
  • North Carolina
    • In the event of a disaster, if a prescriber is unable to provide medical services, Board Rule .1815 states that a pharmacist can issue up to a 90-day supply emergency refill.
  • South Carolina
    • According to South Carolina Law, if a pharmacist is unable to reach a prescriber for refill authorization of a non-controlled substance, under certain circumstances they are permitted to issue an emergency refill of up to a 14-day supply once within a 12-month period.

Evacuations and Curfews

  • Strikethrough indicates removal from evacuation category or warning.
    • As of 10/1, the following Florida counties have issued mandatory evacuation orders: Charlotte County, Citrus County, Clay County, Collier County, Flagler County, Hillsborough County Lee County, Levy County, Pasco County, Sarasota County, St. Johns County, Pinellas County, and Sarasota County.
    • As of 10/1, the following Florida Counties have issued voluntary evacuation orders: Clay County, Franklin County, Gilchrist County, Glades County, Highlands County, Manatee County, Nassau County, Osceola County, Polk County, Putnam County, Orange County, Seminole County, Sumter County, Taylor County, and Volusia County.
  • As of 12:00pm on 10/1 Lee County’s evacuation and curfew have not been lifted.
  • As of 10/1, a curfew is still in effect for Charlotte County including the city of Punta Gorda from 9pm to 6am.
  • As of 9/30, multiple areas in Florida had issued stay at home orders or curfews. Collier County and Naples had a curfew until at least 6pm Friday 9/30. It is unclear if these curfews remain in effect.
  • As of 10/1, North Carolina does not have any evacuation orders or curfews.
  • As of 10/1, South Carolina has not issued any evacuation orders or curfews.

Sheltering

  • The FEMA Daily Ops Brief from 10/1 reports 95 open shelters with 10,054 residents. This is a major decrease overall compared to 9/30.
  • Florida Disaster Maps shows there are 25 open shelters and 8 Special Needs Shelters in the state.
  • Full list and map of shelters, including special needs shelters, open in Florida can be found on the Florida SERT site.
  • List of open American Red Cross shelters can be found here.
  • Florida SERT and Florida Tourism Department have partnered with Expedia to launch an emergency accommodations page. Expedia has reached out to accommodation partners and encouraged them to waive cancellation fees and pet restrictions for evacuees.  

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