Although direct deaths top 100, indirect deaths because of heat stress is still unknown.
The hurricane caused 26 direct and 39 indirect deaths, the majority occurring in Dade county.
"Indirect deaths will be greater in the future, though most NGOs [non-governmental organisations] and the UN ignore them.
The number of indirect deaths – from the destruction of health facilities or infrastructure – run into the millions.
The Royal College of Obstetricians and Gynaecologists and the British Maternal and Fetal Medicine Society BMFMSS) issued a joint statement expressing concern about the level of indirect deaths.
Mr Conetta came to the preliminary conclusion that numbers of indirect deaths above 20,000 were unlikely, mainly because of a lack of specific reports or evidence.
The Scuds were reported to have caused 14 "indirect" deaths, from heart failure or through suffocation resulting from the improper adjustment of gas masks by people putting them on in haste.
The numbers that make it to the history books often do not reflect the indirect deaths that come on the sidelines and aftermath of war, particularly among children 5 years old and younger.
Even with the increase in mortality in the weeks after Hurricane Maria, authorities insisted that the official death toll remained at 55: 20 direct deaths; 31 indirect deaths, such as suicides; and four more from leptospirosis, a waterborne bacterial disease.
In 1952 the "Great Fog", as it became known, was thought to have directly caused around 3,500 deaths from asthma-related conditions the figure for indirect deaths was probably far higher.
A common definition picks out armed conflicts that cause at least 1,000 battle deaths in a year — soldiers and civilians killed by war violence, excluding the difficult-to-quantify indirect deaths resulting from hunger and disease.
