I believe one is never adequately prepared to face a tragedy like the one experienced in the port of Acapulco, Mexico, on October 25th, 2023. While hurricanes are predictable meteorological phenomena, hurricane Otis allowed no time for precautions, rapidly escalating from category 1 to category 5 on the Saffir-Simpson scale in less than 24 h [1]. At 00:25, the hurricane made landfall with wind gusts reaching up to 330 km/h, devastating homes, businesses, and both public and private hospitals in the port.

The night at the main medical care hospital in the state was a nightmare. Almost all windows of the hospital shattered, rapidly flooding the hospitalization wards. Due to the humidity and the power of the wind, some roofs and walls started collapsing.

The scene was chaotic; cries for help from patients requesting bed mobilization, fearful family members, some in tears, intern doctors seeking shelter, wet floors covered in glass, monitor alarms, and people running. One of my colleagues started securing children inside the intensive care unit (ICU).

Sadly, the critically ill patients suffered the most. How do you safely relocate a patient on invasive ventilatory support? There wasn’t enough medical or paramedical staff for such activities at that moment, and there were no oxygen and air outlets in the hallways to connect a mechanical ventilator. It was heart-wrenching to see relatives attempting manual ventilation on them without any prior medical training. “They’re probably ventilating people who are already dead”, remarked one of the resident doctors on duty.

At some point during the night, the power plant failed, plunging the hospital into darkness, rendering medical attention impossible. It was still raining heavily with strong winds, and the only refuge were some corridors or staircases in the hospital. At that moment, there was no secure area within the hospital for patients and their families.

As power was restored, resident doctors walked through the hospital corridors, taking a census of the deceased. “The hospital is in ruins; we want to see our families. Some of the seriously ill patients died during the storm”, said the senior resident in the hospital (Fig. 1).

Fig. 1
figure 1

General Regional Hospital IMSS No. 1 ‘Vicente Guerrero’ in Acapulco, Guerrero, Mexico, on October 26th, 2023, following the passage of hurricane Otis. Photo taken by Celeste Alejandría Muñoz Álvarez

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The following days were no better—no electricity, no clean water in the city, and even less fuel for vehicles. There was also a shortage of food and medications due to looting in all supermarkets and pharmacies. Consequently, hygiene practices were deficient, nutrition was scarce, and chronic patients couldn’t access their treatments.

The health personnel who reported to work in the following days were a small group, hindered by the lack of transportation, impassable streets in some areas of the port, and the insecurity unleashed by the search for food. Some of us suffered severe damage to our homes and morale.

In other cities, people fail to understand when you try to explain what happened. They don’t understand our mood either. We feel broken. Is it perhaps the sorrow for the number of deceased and seeing your hospital in ruins? Is it the miles walked to ascertain if the rest of the family is alive? Is it maybe the years of hard work to buy your now destroyed car? Is it the indifference of the rest of the cities? It hurts that the world moved on.

“At least we’re alive,” is the recurring phrase heard in the hospital corridors. We didn't die, that’s true, but life as we knew it no longer exists, and all that's left is to recover as quickly as possible.

I'm often asked how to help our colleagues. For now, empathy and words of encouragement. We don't know what to do in these cases. We read a lot of science and always try to stay updated, but there is scarce information on these topics.

These phenomena are expected to occur more frequently due to climate change and global warming. Therefore, I write these lines hoping that the medical community can share its experience to address these kinds of situations.