Aside from the usual effects of lingering trauma, the situation may also be part of a vicious cycle in which those who lost their homes and livelihoods in the Katrina tragedy are less likely to be able to cope effectively with their mental health issues -- making true recovery of their former lives even less likely.
"You cannot achieve this without dealing with the mental health issue," Lawry said.
According to a recent editorial Lawry wrote in the journal Disaster Medicine and Public Health Preparedness, conditions in Mississippi and Louisiana were already ripe for problems. Even before the 2005 hurricane season, Louisiana ranked dead last according to certain health and well-being indicators; Mississippi ranked 49th out of 50 states.
In the two states, approximately 1 in 5 people have no health insurance, and both states "rank in the top 5 for highest rates of HIV/AIDS, tuberculosis, sexually transmitted diseases, crude death rates, and infant mortality," Lawry noted in her editorial.
Worse, medical officials in New Orleans said the city's hospitals have yet to return to pre-Katrina capacity. Even accounting for the population decline that occurred after the storm, Dr. Russell Klein, president of the Louisiana State Medical Society, said that the number of beds available is much lower than what you would expect to find -- and lower than what is needed. Before Hurricane Katrina, there were 23 state licensed hospitals in Orleans Parish; in June of this year, only 13 were open.
But where the shortages are really being felt, Klein said, are in general medical surgery units, psychiatrists, primary care physicians, nurses, and other support staff. This translates into a sicker population that is increasingly straining emergency room capabilities. In fact, projections suggest that by next year, the five major New Orleans will be $405 million in debt.
But in some ways, Dr. Klein said, "the shortage in doctors is an easier problem to solve than the shortages in nurses and support staff." This, he said, is because it is hard to recruit people back to the city given the severe shortage of affordable rental units, the school situation, and a general lack of neighborhood amenities.
The fact that such staples have not yet been restored is a major part of the problem for displaced persons as well, Lawry said.
"One thing we know from other disasters around the world is that chronic illnesses do not get better, particularly if the public health infrastructure is destroyed, as was the case with Katrina," she said. "Three years out is a long time in this country to have not resolved some of these issues."
Lawry said that first and foremost, housing issues must be resolved -- a tall order, as more than 30,000 of the 2.5 million people displaced by Katrina still live in FEMA trailers. Health care access must also be improved.
FEMA did not return a telephone message requesting comment on the Katrina disaster and the threat from Gustav. But while the agency's handling of the emergency response from the storm three years ago is still a sore spot for many, Lawry said it is not yet time to assign blame -- particularly since mortality rates in the region have still not leveled off to pre-Katrina levels.
"Who do you blame? I don't know," she said. "You can't levy blame when you are still in the middle of a crisis. With the crude death rate still the same, I think we are still in a crisis."