Getting access to diesel fuel to run generators and potable water is adding to the struggles of hospitals and dialysis providers trying to provide care in devastated Puerto Rico. The island was hit by Hurricane Maria on Sept. 20.

Puerto Rico governor Ricardo Rossello told media outlets that close to a million gallons of gasoline and half a million gallons of diesel fuel are expected over the next few days to keep generators running. The island has approximately 470,000 barrels of gasoline, but getting supplies to medical centers and businesses has been hampered by not having enough trucks and drivers.

The Federal Emergency Management Agency says 51 of 69 hospitals are running in some capacity now, along with 46 of 48 dialysis centers, but the Kidney Community Emergency Response Coalition reports almost all are running on backup systems for power and water.

Mike Spigler, vice president of patient services at the American Kidney Fund, told The Hill that it is an “extremely tenuous situation” for the roughly 5,000 people on the island who rely on dialysis to stay alive. “A lot of (dialysis centers) are down to a day or two of fuel,” he said.

Trucks with gas are having difficulty travelling and are in short supply. “There’s no real dependability on when these trucks are going to show up,” Spigler told the Hill.

Reports from the AKF and KCER say some patients have been showing up for the first time after 10 days without dialysis because of impassable roads and no access to gasoline for their cars.

The sensitivity of patients who need dialysis three times a week has also been noted by Congressional members, who say some deaths have already occurred among those needing treatment.

“We have had people who need dialysis who have been without it for nine days,” House member Steny Hoyer, D-Md., said at a press conference last week. “They are at risk and some have already died. This is a humanitarian crisis and demands the speediest, most robust reaction and action that we can take.”

“We must get patients out of #PuertoRico and to the care they need,” Senator Chuck Schumer, D-NY, tweeted Thursday.

Disaster relief officials have said only 41% of the island has potable water, and only 5% has power.

The Federal Emergency Management Agency said it is working with the U.S. Air Force to evacuate people to the continental United States; more than 100 patients from dialysis clinics damaged or left without power from the storms have been transported off the island.

“Dialysis patients can’t get treatment if there’s no power, and that can become a life-threatening emergency,” said Jerry Dowdy, deputy branch chief for aeromedical plans and operations at Air Mobility Command, Scott Air Force Base, Illinois. “With the total destruction of so much infrastructure, the best way to treat those patients was to get them stateside.”

In Florida, Gov. Rick Scott has declared a state of emergency for all 67 Florida counties in response to the hurricane’s damage. The declaration is intended to make available resources and assistance to help families who are fleeing the destruction and coming to Florida. The state has already coordinated with Florida International University to host evacuees from Puerto Rico and the Virgin Islands, including 90 dialysis patients.

AKF’s Disaster Relief Program is working to provide emergency financial assistance to dialysis patients who have evacuated from Puerto Rico and the U.S. Virgin Islands to the mainland, as well as those patients who remain in Puerto Rico and will need help in the coming weeks and months. This aid will allow them to buy medicine, food, and other essentials. AKF has raised over $370,000 for hurricane relief efforts in Texas, Florida, and Puerto Rico.