For Mr. Rosselló, the funding fight is a question of fairness. For every long-term rebuilding project underway in Puerto Rico at this point after Hurricane Maria, there were 28 projects underway in Texas for damage from Hurricane Harvey, and 32 projects in Louisiana after Hurricane Katrina, the governor said. “Puerto Rico is getting much fewer and much lower resources than any comparable jurisdiction in the United States.”

A University of Michigan analysis published in the journal BMJ Global Health in January found it took twice as long — four months — for Hurricane Maria survivors in Puerto Rico to receive a comparable amount of individual aid (about $1 billion) as Hurricane Harvey survivors in Texas and Hurricane Irma survivors in Florida, though Maria was stronger and more devastating. Maria killed an estimated 2,975 people in Puerto Rico.

In addition to the slow disbursement of aid, a report last month from the Government Accountability Office found that the Department of Housing and Urban Development lacked a robust plan to monitor disaster relief grants, including $20 billion approved for Puerto Rico.

In Vieques, with the hospital out of commission, dialysis patients had to travel to the big island three times a week to get treatment for more than a year after the storm. Several patients died. Finally, in November, a mobile dialysis unit in a shiny trailer arrived at the temporary clinic, allowing local treatments to resume.

“It wasn’t easy,” said Edwin Alvarado Cordero, a 58-year-old diabetic. Standing across the street from the pharmacy in Isabel Segunda, the bigger of the island’s two towns, Mr. Alvarado recounted his thrice-weekly trips from Vieques to Humacao, which began at 4 a.m. and ended at 5:30 p.m.

Last year, on the ferry to the big island, Mr. Alvarado suffered a heart attack. He had open-heart surgery and survived. Though he can now receive dialysis in Vieques, he still travels to San Juan periodically to see his cardiologist. Specialists visit Vieques infrequently.

“It’s far, but it’s better there,” Mr. Alvarado said. “What’s left of the hospital here is grass and horses. They abandoned it.”

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