Across the Caribbean, Building a Resilient Future

Staff at Princess Alexandra Hospital in Anguilla used to spend about three hours a day just filling oxygen canisters, said Malcolm Webster, the hospital's health services coordinator. Often, he simply did it himself to minimize disruption.

He recalled getting a phone call at 2:00 am on a rainy night in the middle of the Covid-19 pandemic. "The hospital was calling: They were out of oxygen on the isolation ward," he said. "Imagine wet tanks, each 100 pounds, slipping all over the place."

For years, Princess Alexandra's staff had expended many hours each week sourcing medical oxygen. A small plant produced oxygen that was then carried to the hospital in 100-pound canisters, although often not enough to meet demand. The rest, like other medical gases, was sourced from elsewhere.

"Medical gases, they aren't produced on the island," Webster explained. "With small islands, that's always the issue…Nitrous oxide comes from Sint Maarten, helium comes from Miami."

And while Anguilla, like other Caribbean nations, collaborates closely with its neighbors to allocate resources and strategize for disasters, Webster was concerned about the need for greater self-sufficiency amid worsening hurricanes.

"Our dependence was always on an outside contractor or a neighboring island" for oxygen and other needs, he explained. For example, Sint Maarten, where Princess Alexandra Hospital sourced a number of medical materials, was severely impacted by Hurricane Irma, a Category 5 storm that battered a destructive path through the Caribbean in September 2017. Procuring medical equipment and supplies after the storm was extremely challenging for Anguilla providers.

"Now, we've come to a place where we are independent of that," Webster said. Princess Alexandra Hospital has been working to procure backup power, prepare for disasters, and care for a high number of patients with severe respiratory illnesses who need piped oxygen - an ongoing concern since the days of the pandemic, according to Webster.

Key to Princess Alexandra Hospital's strategy has been a centralized medical oxygen system that became fully operational three months ago, piping medical-grade oxygen to each of the hospital's 32 beds and providing a highly reliable oxygen source for surgeries, recovery in the intensive care unit, medical emergencies, and every other daily need.

"This for us is a great success story," Webster told Direct Relief. "We've spent a lot of time working on our resilience and making sure our hospital is as self-sufficient as possible."

"Achieving Long-Term Resiliency"

Anguilla's new medical oxygen system is one of ten major projects, totaling $3 million in grants, that Direct Relief has funded in partnership with the Organisation of Eastern Caribbean States, an intergovernmental organization that promotes sustainable development and disaster preparedness across its member states. These resilient energy and infrastructure projects are designed to increase disaster preparedness and make response more efficient throughout the region. Included are resilient power systems installed on hospitals and at the OECS Commission for Disaster and Emergency Management's headquarters in Saint Lucia; procuring mobile medical units for emergency response in Montserrat and Saint Vincent and the Grenadines; epidemiological surveillance in Antigua; and much more.

This focus on healthcare is key to increasing resilience across the Caribbean, said Shanna Emmanuel, the program officer for OECS's Climate and Disaster Resilience Unit. The organization designated healthcare infrastructure as a high priority in the aftermath of Hurricane Beryl, a massive Category 5 storm that killed 33 people in the Caribbean in 2024 and destroyed nearly all structures on some of the islands in Grenada and Saint Vincent and the Grenadines.

"We saw how healthcare really gets hit hard," Emmanuel said. For example, she noted, patients from a hospital on Carriacou, a Grenada island, had to be evacuated to the mainland after Hurricane Beryl. Patients on affected islands struggled to reach medical care because roads and facilities were damaged.

Many of these projects are newly completed and fully operational; a few others are nearing completion. On March 13, OECS officials celebrated the inauguration of a newly completed resiliency project at their commission headquarters that included a resilient power system, a safe water storage system, and an electric vehicle for emergency response operations.

"Proactively strengthening healthcare facilities is key in achieving long-term resiliency and ensuring that our communities have access to the quality care they deserve," said Direct Relief representative Ana Umpierre, speaking at the event. "These efforts are fundamental to improving public health across the region."

The island nations of the Caribbean have played virtually no role in causing climate change (researchers estimate that small-island states worldwide have contributed no more than 1% of all global emissions), but they are on the frontlines of its deadly and fast-growing impacts.

Tropical storms have grown more frequent and severe, causing loss of life and material damage, and limiting access to vital resources at precisely the moment they are most needed. Droughts, extreme heat, habitat loss, and sea level rise have severely impacted Caribbean life, health, economic stability, and well-being.

Hurricane Beryl is a devastating recent example. Direct Relief collaborated closely with OECS to respond to the disaster and prepare for future events. Today, the organization stages Hurricane Preparedness Packs and other large-scale caches of medications and supplies throughout the region and maintains a strategic stockpile for Caribbean emergencies at its regional disaster hub in Puerto Rico.

"Having a way to get power, to get systems back up and running to be able to help those who have been impacted is so important," Emmanuel said. OECS's goal is to "reduce the vulnerability of all people who live…in this region and work in this region and visit this region."

"We can actually see electricity being generated"

In the aftermath of Hurricane Maria - another cataclysmic Category 5 storm that closely followed Hurricane Irma in 2017 - Dominica's heavily damaged China Friendship Hospital struggled to provide much-needed medical care with flooded buildings and inconsistent power.

"The grid system was struggling to provide power to the entire country," recalled Sylvester Henderson, a program manager for Dominica's Ministry of Health. "The facilities were really destroyed."

Today, he explained, the China Friendship Hospital - the only secondary hospital in Dominica, providing specialized medical, emergency, and surgical services for the island nation - operates out of a new, significantly improved facility.

"There is still residual damage from the hurricane" that recently required the hospital's maternal and neonatal services to relocate, said Nicole Laville, director of engineering services for the Dominica Hospitals Authority. "We are actually still feeling the effects of Hurricane Maria."

But key to the new facility's success - and its preparedness for future disasters - is a resilient power system that ensures parts of the hospital can continue to function if the power goes out.

"We can actually see electricity being generated and fed to the grid" through the project's monitoring systems, Laville said.

Even day-to-day, resilient power has been a boon, she told Direct Relief. While offering specialty medical care is an essential priority, it's costly to fund and power.

"Patient care is expensive, so if we can at least save on the utility end, we can direct some of that back into patient care," Laville said.

"During and After Disasters"

In the British Virgin Islands - where Direct Relief-funded projects included a medical oxygen plant, pharmaceutical refrigeration, and several backup power sources - increasing self-sufficiency has been key.

The Direct Relief-funded project "reduces our dependence on emergency imports just as logistics are most disrupted," said Sheniah Armstrong-Jones, deputy secretary for the territory's Ministry of Health and Social Development.

Like Anguilla's Princess Alexandra Hospital, the British Virgin Islands' Dr. D. Orlando Smith Hospital relied on imported medical oxygen - a supply chain that could be quickly interrupted by an emergency, Armstrong-Jones said. Outlying health facilities needed reliable power, so they could preserve cold-chain medications in the event of a power outage and care for patients in the aftermath of a disaster. One required a pharmaceutical-grade refrigerator.

"It was important for us to see that they had the ability to safely store different medications," she told Direct Relief.

While the project is designed to enable greater resilience and continuity of care, Armstrong-Jones said it's also been a deeply meaningful endeavor for the country's medical staff.

"You…saw the genuine happiness" among hospital staff when the medical oxygen system went live in October of 2025, she recalled. "We've been talking about this oxygen system for some time, and now we have it."

"We are vulnerable to sea level rise. We've seen hurricanes get stronger and stronger every year," Armstrong-Jones explained. "We can just have a period in which it rains for 12 hours consistently and the territory floods."

Across the Caribbean, residents and leaders alike are highly aware of the threats posed by climate change. Emmanuel described a system of strategic collaboration - and of open offers of help.

For example, she said, if one nation is hit by a hurricane and can't receive clean water or medical supplies, a neighboring country will step up to receive water and medicine on their behalf. Other Caribbean states will send healthcare workers, civil engineers, and electricians. Surrounding islands will receive people displaced by the damage, and community members will step up to offer housing.

"In this region, we are tied in ways that I think actually help build our resilience. It's our ability to say, 'We are all one'" that speeds recovery after a disaster, Emmanuel said.

Decades of disaster collaboration have made the process more formal, swifter, and more focused on large, resilient systems, Emmanuel said.

"It's really…looking at infrastructure, looking at our ecosystems and looking at our communities," she explained. Equipping hospitals with resilient power and medical oxygen, building out mobile medical units, supporting healthy coastlines with strong mangrove-coral ecosystems, growing climate-resilient traditional foods, and shoring up roads and bridges are all intersecting parts of the same overarching goal: resilience.

The Direct Relief funded projects play an indispensable role in this resilience, according to country leaders.

"These systems are designed to function during and after disasters," Armstrong-Jones said.