Mr. Trudeau returned the criticism, saying Mr. O’Toole’s willingness to ditch Conservative policies and alter his platform mid-campaign showed it was he who would say or promise anything to voters.

While many voters eagerly bumped elbows and posed for selfies with Mr. Trudeau at campaign stops, his campaign was often disturbed by unruly mobs protesting mandatory vaccines and vaccine passports. One event was canceled out of safety concerns, and Mr. Trudeau was pelted with gravel at another.

Mr. Trudeau did have a strong political challenger on the left nationally with Jagmeet Singh of the New Democrats. Mr. Singh, a lawyer and former provincial lawmaker from Ontario, consistently had the highest approval ratings of all the leaders before and during the campaign. But personal popularity was not enough: His party gained three seats but won only a total of 27.

As before the election, the New Democrats are likely to be Mr. Trudeau’s primary source of support in Parliament.

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A Million Afghan Children Could Die in ‘Most Perilous Hour,’ U.N. Warns

Millions of Afghans could run out of food before the arrival of winter and one million children are at risk of starvation and death if their immediate needs are not met, top United Nations officials warned on Monday, putting the country’s plight into stark relief.

Secretary General António Guterres, speaking at a high-level U.N. conference in Geneva convened to address the crisis, said that since the Taliban takeover in Afghanistan last month, the nation’s poverty rate has soared and basic public services have neared collapse and, in the past year, hundreds of thousands of people have been made homeless after being forced to flee fighting.

“After decades of war, suffering and insecurity, they face perhaps their most perilous hour,” Mr. Guterres said, adding that one in three Afghans do not know where they will get their next meal.

The deepening humanitarian crisis tops a dizzying array of challenges confronting the new Taliban regime as it navigates governing a country propped up for decades by aid from international donors.

face potential collapse. At a local hospital in Chak-e Wardak, administrators have been unable to pay salaries or purchase new medicines with banks still closed, according to Faridullah, the facility’s resident doctor.

as drought enveloped the nation.

On Monday, in his first public remarks to Congress, Secretary of State Antony J. Blinken defended the Biden administration’s withdrawal from Afghanistan, saying there was no reason to believe the country would have stabilized had the United States remained.

“There’s no evidence that staying longer would have made the Afghan security forces or the Afghan government any more resilient or self-sustaining,” Mr. Blinken told the House Foreign Affairs Committee, in a live teleconference call. “If 20 years and hundreds of billions of dollars in support, equipment, and training did not suffice, why would another year, or five, or 10, make a difference?”

international aid workers having fled the country out of safety concerns. Those who remain are unsure if they will be able to continue their work.

During the conference on Monday, the U.N. said it needed $606 million in emergency funding to address the immediate crisis, while acknowledging that money alone will not be enough. The organization has pressed the Taliban to provide assurances that aid workers can go about their business safely. By the end of the gathering, international pledges had surpassed the amount requested.

But even as the Taliban sought to make that pledge, the U.N.’s human rights chief, Michelle Bachelet, also speaking in Geneva, said Afghanistan was in a “new and perilous phase” since the militant Islamist group seized power.

“In contradiction to assurances that the Taliban would uphold women’s rights, over the past three weeks, women have instead been progressively excluded from the public sphere,” she said, a warning that the Taliban would need to use more than words to demonstrate their commitment to aid workers’ safety.

Monday’s conference was also intended to drive home the enormousness of the crisis and offer some reassurance to Western governments hesitant to provide assistance that could legitimize the authority of a Taliban government that includes leaders identified by the U.N. as international terrorists with links to Al Qaeda.

their origin story and their record as rulers.

On Sunday, Taliban authorities sent assurances that they would facilitate humanitarian aid deliveries by road, he said.

some $12 billion in assistance to Afghanistan over four years.

While the Taliban did not have a representative in Geneva for the meeting, Zabihullah Mujahid, the Taliban’s deputy information and culture minister, said the government welcomed all humanitarian efforts by any nation, including the United States.

He also acknowledged that not even the Taliban expected to be in control of the country so quickly.

“It was a surprise for us how the former administration abandoned the government,” he said. “We were not fully prepared for that and are still trying to figure things out to manage the crisis and try to help people in any way possible.”

More than half a million Afghans were driven from their homes by fighting and insecurity this year, bringing the total number of people displaced within the country to 3.5 million, Filippo Grandi, the U.N. refugee chief said.

The danger of economic collapse raised the possibility of stoking an outflow of refugees to neighboring countries.

Said, 33, lived in Kunduz before fleeing to Kabul, where he now lives in a tent in a park. He has been there with his wife and three children for a month.

“It’s cold here, we have no food, no shelter, and we can’t find a job in this city,” he said, adding that he had not received any aid. “We all have children and they need food and shelter, and it’s not easy to live here.”

Jim Huylebroek contributed reporting from Chak-e Wardak, Afghanistan. Sami Sahak also contributed reporting.

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Phony Diagnoses Hide High Rates of Drugging at Nursing Homes

The handwritten doctor’s order was just eight words long, but it solved a problem for Dundee Manor, a nursing home in rural South Carolina struggling to handle a new resident with severe dementia.

David Blakeney, 63, was restless and agitated. The home’s doctor wanted him on an antipsychotic medication called Haldol, a powerful sedative.

“Add Dx of schizophrenia for use of Haldol,” read the doctor’s order, using the medical shorthand for “diagnosis.”

But there was no evidence that Mr. Blakeney actually had schizophrenia.

Antipsychotic drugs — which for decades have faced criticism as “chemical straitjackets” — are dangerous for older people with dementia, nearly doubling their chance of death from heart problems, infections, falls and other ailments. But understaffed nursing homes have often used the sedatives so they don’t have to hire more staff to handle residents.

one in 150 people.

Schizophrenia, which often causes delusions, hallucinations and dampened emotions, is almost always diagnosed before the age of 40.

“People don’t just wake up with schizophrenia when they are elderly,” said Dr. Michael Wasserman, a geriatrician and former nursing home executive who has become a critic of the industry. “It’s used to skirt the rules.”

refuge of last resort for people with the disorder, after large psychiatric hospitals closed decades ago.

But unfounded diagnoses are also driving the increase. In May, a report by a federal oversight agency said nearly one-third of long-term nursing home residents with schizophrenia diagnoses in 2018 had no Medicare record of being treated for the condition.

hide serious problems — like inadequate staffing and haphazard care — from government audits and inspectors.

One result of the inaccurate diagnoses is that the government is understating how many of the country’s 1.1 million nursing home residents are on antipsychotic medications.

According to Medicare’s web page that tracks the effort to reduce the use of antipsychotics, fewer than 15 percent of nursing home residents are on such medications. But that figure excludes patients with schizophrenia diagnoses.

To determine the full number of residents being drugged nationally and at specific homes, The Times obtained unfiltered data that was posted on another, little-known Medicare web page, as well as facility-by-facility data that a patient advocacy group got from Medicare via an open records request and shared with The Times.

The figures showed that at least 21 percent of nursing home residents — about 225,000 people — are on antipsychotics.

The Centers for Medicare and Medicaid Services, which oversees nursing homes, is “concerned about this practice as a way to circumvent the protections these regulations afford,” said Catherine Howden, a spokeswoman for the agency, which is known as C.M.S.

“It is unacceptable for a facility to inappropriately classify a resident’s diagnosis to improve their performance measures,” she said. “We will continue to identify facilities which do so and hold them accountable.”

significant drop since 2012 in the share of residents on the drugs.

But when residents with diagnoses like schizophrenia are included, the decline is less than half what the government and industry claim. And when the pandemic hit in 2020, the trend reversed and antipsychotic drug use increased.

For decades, nursing homes have been using drugs to control dementia patients. For nearly as long, there have been calls for reform.

In 1987, President Ronald Reagan signed a law banning the use of drugs that serve the interest of the nursing home or its staff, not the patient.

But the practice persisted. In the early 2000s, studies found that antipsychotic drugs like Seroquel, Zyprexa and Abilify made older people drowsy and more likely to fall. The drugs were also linked to heart problems in people with dementia. More than a dozen clinical trials concluded that the drugs nearly doubled the risk of death for older dementia patients.

11 percent from less than 7 percent, records show.

The diagnoses rose even as nursing homes reported a decline in behaviors associated with the disorder. The number of residents experiencing delusions, for example, fell to 4 percent from 6 percent.

Caring for dementia patients is time- and labor-intensive. Workers need to be trained to handle challenging behaviors like wandering and aggression. But many nursing homes are chronically understaffed and do not pay enough to retain employees, especially the nursing assistants who provide the bulk of residents’ daily care.

Studies have found that the worse a home’s staffing situation, the greater its use of antipsychotic drugs. That suggests that some homes are using the powerful drugs to subdue patients and avoid having to hire extra staff. (Homes with staffing shortages are also the most likely to understate the number of residents on antipsychotics, according to the Times’s analysis of Medicare data.)

more than 200,000 since early last year and is at its lowest level since 1994.

As staffing dropped, the use of antipsychotics rose.

Even some of the country’s leading experts on elder care have been taken aback by the frequency of false diagnoses and the overuse of antipsychotics.

Barbara Coulter Edwards, a senior Medicaid official in the Obama administration, said she had discovered that her father was given an incorrect diagnosis of psychosis in the nursing home where he lived even though he had dementia.

“I just was shocked,” Ms. Edwards said. “And the first thing that flashed through my head was this covers a lot of ills for this nursing home if they want to give him drugs.”

Homes that violate the rules face few consequences.

In 2019 and 2021, Medicare said it planned to conduct targeted inspections to examine the issue of false schizophrenia diagnoses, but those plans were repeatedly put on hold because of the pandemic.

In an analysis of government inspection reports, The Times found about 5,600 instances of inspectors citing nursing homes for misusing antipsychotic medications. Nursing home officials told inspectors that they were dispensing the powerful drugs to frail patients for reasons that ranged from “health maintenance” to efforts to deal with residents who were “whining” or “asking for help.”

a state inspector cited Hialeah Shores for giving a false schizophrenia diagnosis to a woman. She was so heavily dosed with antipsychotics that the inspector was unable to rouse her on three consecutive days.

There was no evidence that the woman had been experiencing the delusions common in people with schizophrenia, the inspector found. Instead, staff at the nursing home said she had been “resistive and noncooperative with care.”

Dr. Jonathan Evans, a medical director for nursing homes in Virginia who reviewed the inspector’s findings for The Times, described the woman’s fear and resistance as “classic dementia behavior.”

“This wasn’t five-star care,” said Dr. Evans, who previously was president of a group that represents medical staff in nursing homes. He said he was alarmed that the inspector had decided the violation caused only “minimal harm or potential for harm” to the patient, despite her heavy sedation. As a result, he said, “there’s nothing about this that would deter this facility from doing this again.”

Representatives of Hialeah Shores declined to comment.

Seven of the 52 homes on the inspector general’s list were owned by a large Texas company, Daybreak Venture. At four of those homes, the official rate of antipsychotic drug use for long-term residents was zero, while the actual rate was much higher, according to the Times analysis comparing official C.M.S. figures with unpublished data obtained by the California advocacy group.

make people drowsy and increases the risk of falls. Peer-reviewed studies have shown that it does not help with dementia, and the government has not approved it for that use.

But prescriptions of Depakote and similar anti-seizure drugs have accelerated since the government started publicly reporting nursing homes’ use of antipsychotics.

Between 2015 and 2018, the most recent data available, the use of anti-seizure drugs rose 15 percent in nursing home residents with dementia, according to an analysis of Medicare insurance claims that researchers at the University of Michigan prepared for The Times.

in a “sprinkle” form that makes it easy to slip into food undetected.

“It’s a drug that’s tailor-made to chemically restrain residents without anybody knowing,” he said.

In the early 2000s, Depakote’s manufacturer, Abbott Laboratories, began falsely pitching the drug to nursing homes as a way to sidestep the 1987 law prohibiting facilities from using drugs as “chemical restraints,” according to a federal whistle-blower lawsuit filed by a former Abbott saleswoman.

According to the lawsuit, Abbott’s representatives told pharmacists and nurses that Depakote would “fly under the radar screen” of federal regulations.

Abbott settled the lawsuit in 2012, agreeing to pay the government $1.5 billion to resolve allegations that it had improperly marketed the drugs, including to nursing homes.

Nursing homes are required to report to federal regulators how many of their patients take a wide variety of psychotropic drugs — not just antipsychotics but also anti-anxiety medications, antidepressants and sleeping pills. But homes do not have to report Depakote or similar drugs to the federal government.

“It is like an arrow pointing to that class of medications, like ‘Use us, use us!’” Dr. Maust said. “No one is keeping track of this.”

published a brochure titled “Nursing Homes: Times have changed.”

“Nursing homes have replaced restraints and antipsychotic medications with robust activity programs, religious services, social workers and resident councils so that residents can be mentally, physically and socially engaged,” the colorful two-page leaflet boasted.

Last year, though, the industry teamed up with drug companies and others to push Congress and federal regulators to broaden the list of conditions under which antipsychotics don’t need to be publicly disclosed.

“There is specific and compelling evidence that psychotropics are underutilized in treating dementia and it is time for C.M.S. to re-evaluate its regulations,” wrote Jim Scott, the chairman of the Alliance for Aging Research, which is coordinating the campaign.

The lobbying was financed by drug companies including Avanir Pharmaceuticals and Acadia Pharmaceuticals. Both have tried — and so far failed — to get their drugs approved for treating patients with dementia. (In 2019, Avanir agreed to pay $108 million to settle charges that it had inappropriately marketed its drug for use in dementia patients in nursing homes.)

Ms. Blakeney said that only after hiring a lawyer to sue Dundee Manor for her husband’s death did she learn he had been on Haldol and other powerful drugs. (Dundee Manor has denied Ms. Blakeney’s claims in court filings.)

During her visits, though, Ms. Blakeney noticed that many residents were sleeping most of the time. A pair of women, in particular, always caught her attention. “There were two of them, laying in the same room, like they were dead,” she said.

In his first few months at Dundee Manor, Mr. Blakeney was in and out of the hospital, for bedsores, pneumonia and dehydration. During one hospital visit in December, a doctor noted that Mr. Blakeney was unable to communicate and could no longer walk.

“Hold the patient’s Ambien, trazodone and Zyprexa because of his mental status changes,” the doctor wrote. “Hold his Haldol.”

Mr. Blakeney continued to be prescribed the drugs after he returned to Dundee Manor. By April 2017, the bedsore on his right heel — a result, in part, of his rarely getting out of bed or his wheelchair — required the foot to be amputated.

In June, after weeks of fruitless searching for another nursing home, Ms. Blakeney found one and transferred him there. Later that month, he died.

“I tried to get him out — I tried and tried and tried,” his wife said. “But when I did get him out, it was too late.”

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Hurricane Ida Exposes Grid Weaknesses as New Orleans Goes Dark

Most of New Orleans went dark on Sunday after Hurricane Ida took out transmission lines and forced power plants offline. It was an all too familiar scene in a city that has often lost power during big storms.

But this was an outage that was never supposed to happen. The utility company Entergy opened a new natural gas power plant in the city last year, pledging that it would help keep the lights on — even during hot summer days and big storms. It was one of two natural gas plants commissioned in recent years in the New Orleans area, the other one hailed by Gov. John Bel Edwards last year as a “source of clean energy that gives our state a competitive advantage and helps our communities grow.”

The storm raises fresh questions about how well the energy industry has prepared for natural disasters, which many scientists believe are becoming more common because of climate change. This year, much of Texas was shrouded in darkness after a winter storm, and last summer officials in California ordered rolling blackouts during a heat wave.

More than a million residential and commercial customers in Louisiana were without power on Monday afternoon, and Entergy and other utilities serving the state said it would take days to assess the damage to their equipment and weeks to fully restore service across the state. One customer can be a family or a large business, so the number of people without power is most likely many times higher. In neighboring Mississippi, just under 100,000 customers were without power.

some of California’s largest and deadliest wildfires.

impossible for Texas to import power by keeping the state grid largely isolated from the rest of the country to avoid federal oversight.

add more transmission lines to carry more solar and wind power from one region of the country to another. But some energy experts said the increasing frequency of devastating hurricanes, wildfires and other disasters argues against a big investment in power lines and for greater investment in smaller-scale systems like rooftop solar panels and batteries. Because small systems are placed at many homes, businesses, schools and other buildings, some continue to function even when others are damaged, providing much-needed energy during and after disasters.

Susan Guidry, a former member of the New Orleans City Council who voted against the Entergy plant, said she had worried that a storm like Ida could wreak havoc on her city and its energy system. She had wanted the city and utility to consider other options. But she said her fellow Council members and the utility had ignored those warnings.

“They said that they had dealt with that problem,” Ms. Guidry said. “The bottom line is they should have instead been upgrading their transmission and investing in renewable energy.”

Numerous community groups and city leaders opposed the gas-fired power plant, which is just south of Interstate 10 and Lake Pontchartrain, bordering predominantly African American and Vietnamese American neighborhoods. Nevertheless, the City Council approved the plant, which began commercial operations in May 2020. It generates power mainly at times of peak demand.

About a year earlier, Entergy opened a larger gas power plant in nearby St. Charles Parish. Leo P. Denault, Entergy’s chairman and chief executive, last year called that plant “a significant milestone along the clean energy journey we began more than 20 years ago.”

Some utilities have turned to burying transmission lines to protect them from strong winds and storms, but Mr. Gasteiger said that was expensive and could cause its own problems.

“Generally speaking, it’s not that the utilities are not willing to do it,” he said. “It’s that people aren’t willing to pay for it. Usually it’s a cost issue. And undergrounding can make it more difficult to locate and fix” problems.

Big changes to electric grids and power plants are likely to take years, but activists and residents of New Orleans say officials should explore solutions that can be rolled out more quickly, especially as tens of thousands of people face days or weeks without electricity. Some activists want officials to put a priority on investments in rooftop solar, batteries and microgrids, which can power homes and commercial buildings even when the larger grid goes down.

“We keep walking by the solutions to keep people safe in their homes,” said Logan Atkinson Burke, executive director of the Alliance for Affordable Energy, a consumer group based in New Orleans. “When these events happen, then we’re in crisis mode because instead we’re spending billions of dollars every year now to rebuild the same system that leaves people in the dark, in a dire situation.”

Some residents have already invested in small-scale energy systems for themselves. Julie Graybill and her husband, Bob Smith, installed solar panels and batteries at their New Orleans home after Hurricane Isaac blew through Louisiana in 2012. They lost power for five days after Isaac, at times going to their car for air-conditioning with their two older dogs, said Ms. Graybill, 67, who retired from the Tulane University School of Medicine.

“We would sit in the car about every hour,” she said. “My husband said, ‘We are never doing this again.’” Mr. Smith, 73, who is also retired, worked as an engineer at Royal Dutch Shell, the oil company.

The couple have set up a little power station on their porch so neighbors can charge their phones and other items. Only a few other homes on their street have solar panels, but no one else nearby has batteries, which can store the power that panels generate and dispense it when the grid goes down.

“We’re told we’re not going to have power for three weeks,” Ms. Graybill said. “The only people who have power are people with generators or solar panels. We lived through Katrina. This is not Katrina, so we’re lucky.”

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Hurricane Ida News: Storm Could Be Among the Strongest to Hit Louisiana since the 1850s, Governor Warns

saying local officials expected “the possibility of flooding and even spinoff tornadoes in portions of Alabama.” In Mississippi, Gov. Tate Reeves also issued a state of emergency on Saturday, allowing for the use of state resources for response and recovery.

Research over the past decade has found that, on average, such rapid intensification of hurricanes is increasing, in part because the oceans, which provide the energy for hurricanes, are getting warmer as a result of human-caused emissions of greenhouse gases. But Ida will also strengthen quickly because the Gulf, as is usual at the end of the summer, is very warm.

The hurricane center defines rapid intensification as at least a 35-m.p.h. increase in sustained winds over 24 hours. In the extremely active 2020 season, Hurricane Laura intensified by 45 m.p.h. in the 24 hours before making landfall in Louisiana as a Category 4 storm in late August.

The National Hurricane Center said Ida was likely to produce heavy rainfall late Sunday into Monday from southeast Louisiana to coastal Mississippi and Alabama. Tropical storm force winds will arrive along the coast as early as Saturday night, according to the National Weather Service, before the storm makes landfall on Sunday afternoon or evening. After moving inland, the storm could contribute to flooding in Tennessee, where flash flooding killed 20 people last weekend.

“Based upon current track and strength of Ida, this storm will test our hurricane protection systems in a way they haven’t been tested before,” Chip Kline, executive assistant to the governor of Louisiana for coastal activities, said on Twitter. “It’s times like these that remind us of the importance of continuing to protect south Louisiana.”

Correction: 

Because of an editing error, an earlier version of this article misidentified the location of Tropical Storm Ida. It was in the Caribbean Sea early Friday, not the Gulf of Mexico.

Bella Witherspoon, left, and Sara Marriott prepare their boat ahead of the arrival of Hurricane Ida in Ocean Springs, on the Mississippi coast.
Credit…Hannah Ruhoff/The Sun Herald, via Associated Press

Hurricane Ida will produce “life-threatening” weather conditions in Louisiana and batter parts of Mississippi, the National Weather Service said, urging people to evacuate inland.

Here is a breakdown of how various parts of the region could be affected when the hurricane makes landfall on Sunday afternoon or evening , according to the Weather Service.

Baton Rouge, La.

River Parishes and Northshore in Louisiana

New Orleans

Coastal Louisiana

Southwest Mississippi

Coastal Mississippi

Jawan Williams shoveled sand for a sandbag held by his son Jayden Williams, before landfall of Hurricane Ida at the Frederick Sigur Civic Center in Chalmette, La., on Saturday.
Credit…Matthew Hinton/Associated Press

Hurricane Ida is expected to make landfall Sunday, threatening to bring dangerous wind, storm surge and rain to the Gulf Coast exactly 16 years after the arrival of Hurricane Katrina, one of the most costly natural disasters in American history, which left more than 1,800 dead and produced more than $100 billion in damages.

The overall impact of storm surge from Ida is predicted to be less severe than during Katrina. Because that storm began as a Category 5 hurricane in the Gulf of Mexico before weakening as it approached landfall, it generated enormous storm surge, which brought over 20 feet of water to parts of the Mississippi coast. Current projections put the storm surge of Ida at 10 to 15 feet.

“Fifteen-foot sure can do a lot of damage,” said Barry Keim, a professor at Louisiana State University and Louisiana State Climatologist. “But it’s going to be nothing in comparison with Katrina’s surge.”

Improvements to the levee system following Katrina have better prepared the New Orleans metro area for the storm surge.

However, the areas likely to receive the most severe surge from Ida may be less equipped to handle it than the area hit by Katrina, said Dr. Keim.

Ida is expected to make landfall to the west of where Katrina struck, bringing the most severe storm surge impacts to the Louisiana coast west of the Mississippi River rather than east of the river along coastal Mississippi, as Katrina did.

“We are testing a different part of the flood protection in and around southeast Louisiana than we did in Katrina,” said Dr. Keim. “Some of the weak links in this area maybe haven’t been quite as exposed.”

While the impacts of Ida’s storm surge are expected to be less severe than Katrina’s, Ida’s winds and rain are predicted to exceed those that pummeled the Gulf Coast in 2005.

Ida is expected to make landfall on the Gulf Coast as a Category 4 storm with peak winds of 130 mph, while Katrina made landfall as a Category 3 with peak winds of 125 mph.

“It could be quite devastating — especially some of those high rise buildings are just not rated to sustain that wind load,” said Jamie Rhome, acting deputy director of the National Hurricane Center.

The severe damage from Hurricane Laura, which struck southwest Louisiana last year as a Category 4 storm, was caused primarily by high winds peaking at 150 mph. The storm caused 42 deaths and damage costing more than $19 billion.

Ida’s rainfall also threatens to exceed Katrina’s highs.

The National Hurricane Center estimates that Ida will drench the Gulf Coast with 8 to 16 inches of rain and perhaps as much as 20 inches in some places. Katrina brought 5-10 inches of rain with more than 12 inches in the most impacted areas.

“That is a lot of rainfall,” said Mr. Rhome. “Absolutely the flash flood potential in this case is high, very high.” Especially combined with storm surge, he said, such intense levels of rainfall could have a “huge and devastating impact to those local communities.”

A wedding party marches by boarded-up buildings in the French Quarter in New Orleans on Saturday.
Credit…Dan Anderson/EPA, via Shutterstock

NEW ORLEANS — When a hurricane comes roaring toward New Orleans out of the Gulf of Mexico, there is a discernible mood shift on Bourbon Street, the city’s famed strip of iniquity and conspicuous alcohol consumption.

It goes from tawdry to tawdry with a hint of apocalypse. On Friday afternoon, the street was half alive. Daiquiri bars were open and daiquiri bars were boarded up. The doors to Larry Flynt’s Hustler Club were locked. Nearby, a man lay on his back on the sidewalk, a plastic bag at his side, yelling the name “Laura.” Or maybe “Lord.”

Six happy women from New York ambled toward Canal Street in matching black T-shirts that said, “Birthday, beignets and booze.” The birthday girl declined to give her name. They went past the club called The Famous Door, where a listless bar band played “Fat Bottomed Girls.”

The riffs poured out into the street. A member of the birthday team raised a glass of something alcoholic and sugary and shouted out the chorus.

Another of the New York women, Jessika Edouard of Long Island, said that most of her group had been trying to get out of town before the storm’s arrival, to no avail. It was all cancellations and unresponsive airline customer service. “The flights are terrible,” she said.

What choice did they have but to keep the party going? Ms Edouard thought she and some of the others might be able to leave on Monday, after Ida hit.

In the meantime, she said, they had bought a ton of booze in the French Quarter. In the morning they had beignets. They had just met a crew from the Weather Channel. They seemed more excited than scared.

Ms. Edouard even had words for the storm, which she delivered like a threat from one pro wrestler to another.

“If Hurricane Ida thinks she is going to ruin my friend’s 30th birthday, then Ida has another thing coming,” she said.

New Orleans residents prepared to leave after the mayor asked for voluntary evacuations in anticipation of Hurricane Ida.
Credit…Max Becherer/NOLA.com, via The Advocate, via Associated Press

NEW ORLEANS — With Hurricane Ida likely to bring powerful winds and heavy rain to their city, residents of New Orleans faced a familiar choice: flee or hunker down for the duration.

The storm was expected to make landfall by Sunday afternoon or evening and officials urged people who intended to evacuate to do so by Saturday. Residents came to a variety of decisions on the matter.

Lacy Duhe, 39, and Jeremy Housely, 42, opted to hunker down in their second-story apartment on Deslonde Street in New Orlean’s Lower Ninth Ward. If they evacuated and ended up in a shelter, they said, they worried about the risk of their unvaccinated children contracting Covid-19. They also had just paid their monthly bills and could not afford to go anywhere.

“It feels serious,” said the couple’s 11-year-old daughter, Ja-nyi. “I wasn’t born during Katrina time. But I know it knocked down a lot of places.”

Mary Picot, 71, walked out the door on Saturday afternoon carrying bags of snacks and medicine. She wasn’t worried about flooding and believed the levees would hold. It was the threat of power outages that convinced her to leave.

“My husband is diabetic,” she said. “We have to keep his medicine cold.”

Donald Lyons, 38, was packing up a silver Nissan sedan Saturday afternoon under a cloud-filled sky in Hollygrove, one of the traditionally Black working class neighborhoods that flooded badly when Katrina hit. The car, carrying his wife, three children and mother-in-law, was full of bags and bedding. They were heading to Sugar Land, Texas, 27 miles southwest of Houston, where they had family that had left after Katrina, 16 years ago, and never come back.

“I’m just trying to get somewhere safe,” Mr. Lyons said.

Down the block, Barbara Butler, 65, a housekeeper, said she thought the city was safer now with all of the new flood protection. She intended to ride out the storm at home.

“It gave us some relief,” she said. “It’s better than no relief.”

She was sitting on the porch with her husband, Curtis Duck, 63, and her brother, Ray Thomas, in a house that Ms. Butler said was flooded with eight feet of water after Katrina.

Mr. Duck said he was sick of evacuating time and again.

“We listen to the news,” he said. “People telling us to go, go, go.”

Victor Pizarro, a health advocate, and his husband decided to ride out the storm in their home in the Gentilly Terrace neighborhood, although they said they would leave town if they lost power for an extended period.

“It’s definitely triggering to even have to think about this and make these decisions,” Mr. Pizarro said in a telephone interview while he drove across town in search of a spare part for his generator. “It’s exhausting to be a New Orleanian and a Louisianian at this point.”

Andy Horowitz and his family decided to vacate their home in the Algiers Point neighborhood, which sits directly across the Mississippi River from the French Quarter. Mr. Horowitz is the author of “Katrina: A History, 1915-2015,” and he is among those scholars and Louisiana residents who fear that the city’s new flood protection system, as massive as it is, may prove to be inadequate for a sinking city in the likely path of more frequent and powerful storms in the age of climate change.

“Every summer, New Orleans plays a game of Russian roulette, and every summer we pull the trigger,” Mr. Horowitz said.

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New Orleans Mayor Urges Evacuations Ahead of Hurricane Ida

Hurricane Ida is expected to make landfall as a Category 4 storm on Sunday, which is also the 16th anniversary of Hurricane Katrina. Mayor LaToya Cantrell warned residents to either evacuate immediately or bunker down in a safe place ahead of the hurricane.

What we know is today, right now, everyone has to make a decision to leave voluntarily, which I’m recommending, do that, prepare yourselves. If you’re going to leave, you need to do that now. We need to make sure that you are in a safe place, everyone, whether you’re going to leave voluntarily or stay onsite, hunkered down. Wherever that is, hopefully that’s your home, in our city, but in a safe space. Prepare for damaging wind, power outages, heavy rain, tornadoes. What I am told is that this storm in no way will be weakening. There will be and there are no signs, again, that this storm will weaken, and there’s always an opportunity for the storm to strengthen. This continues to remain a very fluid situation. And we know, again, that time is not on our side. It’s just, it’s rapidly, it’s growing, it’s intensifying.

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Hurricane Ida is expected to make landfall as a Category 4 storm on Sunday, which is also the 16th anniversary of Hurricane Katrina. Mayor LaToya Cantrell warned residents to either evacuate immediately or bunker down in a safe place ahead of the hurricane.CreditCredit…Matthew Hinton, via Associated Press

NEW ORLEANS — With tracking maps for Hurricane Ida consistently showing an expected pathway toward southeast Louisiana, Mayor LaToya Cantrell of New Orleans issued a stern warning on Saturday that city residents who intend to leave should do so immediately.

“In no way will this storm be weakening, and there’s always an opportunity for the storm to strengthen,” Ms. Cantrell said at a news briefing. “Time is not on our side. It’s rapidly growing, it’s intensifying.”

City officials are asking that residents who plan to stay in the city prepare for extended power outages, limited emergency services and several days of high temperatures after the storm passes.

“The first 72 is on you,” said Collin Arnold, director of the New Orleans Office of Homeland Security and Emergency Preparedness. “The first three days of this will be difficult for responders to get to you.”

Forecasters are predicting that Hurricane Ida will be a Category 4 storm upon landfall on Sunday, the 16th anniversary of Hurricane Katrina, which left more than 1,800 dead.

“What we learned during Hurricane Katrina is we are all first-responders,” Ms. Cantrell said. “It’s about taking care of one another.”

Delery Street in the Ninth Ward of New Orleans was flooded after Hurricane Katrina in 2005.
Credit…Nicole Bengiveno/ New York Times

NEW ORLEANS — On Saturday afternoon, the Rev. Willie L. Calhoun Jr., a 71-year-old resident of the Lower Ninth Ward, was in his Lincoln Continental on the brink of getting out of town. He was not quite sure where. Somewhere in Alabama, he figured.

Rev. Calhoun remembers his father smashing a hole in the roof of his family’s home in the Lower Ninth in 1965, when Hurricane Betsy put 10 feet of water in his house. When Katrina came, he and his family made sure to get out of the neighborhood before the storm destroyed their homes — unlike many of his neighbors, some of whom perished when the levees failed.

The pain from Katrina was now an indelible fact of life in the neighborhood. He had hoped to take part in a 16th anniversary commemoration on Sunday, with a high school marching band and a theme, he said, of “healing, unifying and strengthening our communities.”

“The trauma, and the hurt that’s there,” he said. “I have one friend who lost his mother and his granddaughter in Katrina. For that trauma to be revisited every year is a tough thing.”

But his perspective on the neighborhood 16 years on was somewhat nuanced. He felt confident that the improvements to the city’s storm protection system — with its mammoth flood walls and new gates and levees — would keep the Ninth Ward safe. His worry, he said, was the damage from the wind that comes with a Category 4 hurricane.

And yet it was difficult not to be disappointed. The jobs for Black men seemed to have dried up in the city. A revamped post-Katrina educational system, heavily reliant on charter schools, did not seem, in Rev. Calhoun’s opinion, to have done much good. The neighborhood was in need of economic stimulus. Still full of empty lots, and ghostly foundations of homes, many of them owned by Black families, long washed away.

After $20 billion in infrastructure improvements, it felt, at best, like partial progress, and like survival with an asterisk.

Credit…Adrees Latif/Reuters

LAKE CHARLES, La. — Not again. That was the widespread sentiment among residents of Lake Charles, a city of about 76,000 residents some 200 miles from New Orleans, on Saturday.

A year after Hurricane Laura left many here without power — and some without homes — for long periods of time, residents were preparing for perhaps yet another weather catastrophe.

When Laura, a powerful Category 4 storm, barreled through Lake Charles last August, it shattered the windows of the home that Juan Jose Galdames, 55, a construction worker, shared with his five children. On Saturday, he was at Home Depot, buying plywood to protect the windows and other vulnerable parts of his house ahead of the storm.

“Yes, I am a little afraid,” Mr. Galdames said. “I don’t want a repeat of that day. It was scary. I want my children to feel safe. I’m trying to get everything ready before nightfall.”

Water and bread were in short supply at an area Target store, and traffic stretched for miles as residents sought safety elsewhere.

Tracy Guillory, 57, a carpenter, tried to prepare by stocking up on supplies and staying on top of weather reports. She said she and her family were weary after a long year of weather crises that included Hurricane Delta and a winter storm that caused pipes to burst and knocked out water systems throughout the region.

Ms. Guillory said her neighborhood was still recovering from flooding in May, which left her SUV beyond repair. She plans to hunker down with her 83-year-old father and 21-year-old daughter.

Josue Espinal, 34, who also works in construction, was trying to reassure his 4-year-old son, Anderson, that everything would be all right. The boy sat on top of a generator box as his father loaded a cart with bottles of water at a Home Depot. Truth was, Mr. Espinal admitted, he too was worried. He and his family live in a mobile home near a lake, and he was looking for a better option to spend the next two nights.

A medical worker monitored a Covid-19 patient in the intensive care unit at Lake Charles Memorial Hospital in Louisiana earlier this month.
Credit…Mario Tama/Getty Images

In Louisiana, where daily deaths from Covid reached their highest levels this week, stretched hospitals are having to modify the intense preparations they would normally make ahead of an expected strike from Hurricane Ida.

Louisiana’s medical director, Dr. Joseph Kanter, asked residents on Friday to avoid unnecessary emergency room visits to preserve the state’s hospital capacity, which has been vastly diminished by its most severe Covid surge of the pandemic.

And while plans exist to transfer patients away from coastal areas to inland hospitals ahead of a hurricane, this time “evacuations are just not possible,” Gov. John Bel Edwards said at a news conference.

“The hospitals don’t have room,” he said. “We don’t have any place to bring those patients — not in state, not out of state.”

The governor said officials had asked hospitals to check generators and stockpile more water, oxygen and personal protective supplies than usual for a storm. The implications of a strike from a Category 4 hurricane while hospitals were full were “beyond what our normal plans are,” he added.

Mr. Edwards said he had told President Biden and Deanne Criswell, the administrator of the Federal Emergency Management Agency, to expect Covid-related emergency requests, including oxygen.

The state’s recent wave of Covid hospitalizations has exceeded its previous three peaks, and staffing shortages have necessitated support from federal and military medical teams. On Friday, 2,684 Covid patients were hospitalized in the state. This week Louisiana reported its highest ever single-day death toll from Covid — 139 people.

Oschner Health, one of the largest local medical systems, informed the state that it had limited capacity to accept storm-related transfers, especially from nursing homes, the group’s chief executive, Warner L. Thomas, said. Many of Oschner’s hospitals, which were caring for 836 Covid patients on Friday, had invested in backup power and water systems to reduce the need to evacuate, he said.

The pandemic also complicated efforts to discharge more patients than usual before the storm hits. For many Covid patients who require oxygen, “going home isn’t really an option,” said Stephanie Manson, chief operating officer of Our Lady of the Lake Regional Medical Center in Baton Rouge, which had 190 Covid inpatients on Friday, 79 of them in intensive care units.

The governor said he feared that the movement of tens or hundreds of thousands of evacuees in the state could cause it to lose gains made in recent days as the number of new coronavirus cases began to drop. Dr. Kanter urged residents who were on the move to wear masks and observe social distancing. Many of the state’s testing and vaccination sites were slated to close temporarily.

The Inner Harbor Navigation Canal Surge Barrier was constructed after Hurricane Katrina to prevent tidal surges from hurricanes from reaching New Orleans.
Credit…Gerald Herbert/Associated Press

NEW ORLEANS — As Hurricane Ida heads toward a possible Sunday landfall on Louisiana’s coastline, the National Weather Service’s storm surge forecast has local officials warning about the potential for water to overtop some of the levees that protect parts of New Orleans.

Mayor LaToya Cantrell of New Orleans noted at a news briefing on Friday evening that water overtopping the levees “is as it was structured to do.” That reflects the updates to the local system of earthen and reinforced levees that protects much of southeast Louisiana in the years after Hurricane Katrina stretched it to a breaking point.

The system, officials said, was rebuilt to defend against a so-called “100-year-storm,” or a storm that has a 1 percent chance in happening every year, but to remain reinforced up to a 500-year-event. It includes armoring, splash pads — concrete areas designed to keep the ground behind an overtopped wall from being washed away — and pumps with backup generators, officials said.

Heath Jones, an emergency operation manager with the Army Corps of Engineers, said that some levees protecting New Orleans on the western side of the Mississippi River were at risk of overtopping in line with the Weather Service’s forecast calling for between 10 and 15 feet of storm surge. A federal levee database shows sections of levee there as low as 10 feet.

Levees in this part of the state have rarely been challenged since they were shored up in the years after Hurricane Katrina in 2005.

“The previous big tests were (hurricanes) Isaac and Gustav,” said Matt Roe, a public affairs specialist with the Army Corps of Engineers, which occurred in 2012 and 2008, “but it’s important to note that each storm is different.”

Ida’s strength, according to Chip Cline, chairman of the Coastal Protection and Restoration Authority, “will test our hurricane protection system in a way they haven’t been tested before.”

Homes in Lake Charles, La., were covered with blue tarps after being hit by Hurricane Laura. Then Hurricane Delta swept through, knocking down trees and scattering debris from the previous storm.
Credit…William Widmer for The New York Times

Hurricane Ida threatens to be the first major storm to strike the Gulf Coast during the 2021 season, hitting a region in many ways still grappling with the physical and emotional toll of a punishing run of hurricanes last year.

The Atlantic hurricane season of 2020 was the busiest on record, with 30 named storms, 13 of which reached hurricane strength. There were so many storms that forecasters ran through the alphabet and had to take the rare step of calling storms by Greek letters.

Louisiana was dealt the harshest blow, barraged repeatedly by storms, including Hurricane Laura, which was one of the most powerful to hit the state, trailed six weeks later by Delta, which was weaker than Laura but followed a nearly identical path, inflicting considerable pain on communities still gripped by the devastation from the earlier storm.

The state is still struggling to claw its way back. Gov. John Bel Edwards of Louisiana said the state had $3 billion in unmet recovery needs. In Lake Charles, which was ravaged by direct hits from both hurricanes followed by a deadly winter storm and flooding in May, local officials recently renewed a plea for federal aid as the city has failed to regain its footing; much of it has yet to recover and many residents, unable to find adequate or affordable housing, have fled.

The looming impact of Ida underscores the persisting danger imperiling coastal communities as a changing climate stands to intensify the destructive force of the storms that have always been a seasonal part of life.

President Biden cited the growing danger in May when he announced a significant increase in funding to build and bolster infrastructure in communities most likely to face the wrath of extreme weather.

A fallen tree and electricity pole were cleared as Hurricane Nora approaches Manzanillo, Mexico, on Sunday.
Credit…Reuters

Hurricane Nora formed in the eastern Pacific on Saturday morning, threatening much of Mexico’s western coastline as the storm strengthens and barrels its way toward Puerto Vallarta, Jalisco and the tip of the Baja California Peninsula, forecasters said.

As of 10 a.m. on Saturday, Nora was about 425 miles from Cabo San Lucas, Mexico, and had maximum sustained winds of 80 miles per hour as it moved north, according to the National Hurricane Center.

A hurricane warning was in effect for parts of western Mexico.

Forecasters said the storm was expected to cause flooding, mudslides and perilous surf along much of Mexico’s central and northern Pacific Coast.

The remnants of the storm are expected to produce heavy rainfall in parts of the southwestern U.S. and central Rockies toward the middle of next week, forecasters said.

A forecast track from the National Hurricane Center showed Nora skirting close to Mexico’s coastline by Sunday morning before moving toward the Gulf of California a day later.

“Some additional strengthening is forecast through tonight if Nora’s center does not make landfall,” the National Hurricane Center said in an update. “Some gradual weakening is expected to begin by Sunday night or Monday, but Nora is forecast to remain as a hurricane through Tuesday.”

Nora is expected to produce rainfall totals of up to 12 inches this weekend along Mexico’s western coast.

It has been a dizzying few weeks for meteorologists who are monitoring Hurricane Ida this weekend after having monitored three named storms that formed in quick succession in the Atlantic, bringing stormy weather, flooding and damaging winds to different parts of the United States and the Caribbean.

The links between hurricanes and climate change are becoming more apparent. A warming planet can expect to see stronger hurricanes over time, and a higher incidence of the most powerful storms — though the overall number of storms could drop because factors like stronger wind shear could keep weaker storms from forming.

Hurricanes are also becoming wetter because of more water vapor in the warmer atmosphere; scientists have suggested that storms like Hurricane Harvey in 2017 produced far more rain than they would have without the human effects on climate. Also, rising sea levels are contributing to higher storm surges — the most destructive element of tropical cyclones.

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U.S. Launches Strike on ISIS-K as Bombing’s Death Toll Soars

The U.S. military said on Friday night that it had launched its first reprisal strike for the devastating suicide bombing at Kabul’s airport the day before, using a drone to target and apparently kill a planner for the group that claimed responsibility for the deaths of as many as 170 civilians and 13 U.S. service members.

“U.S. military forces conducted an over-the-horizon counterterrorism operation today against an ISIS-K planner,” Capt. Bill Urban, a spokesman for U.S. Central Command, said in a statement, referring to the Islamic State affiliate in Afghanistan, also known as Islamic State Khorasan.

“The unmanned airstrike occurred in the Nangarhar Province of Afghanistan,” Captain Urban said. “Initial indications are that we killed the target. We know of no civilian casualties.”

The attack at the airport on Thursday was one of the deadliest bombings in the nearly two decades since the U.S.-led invasion. American officials believe “another terror attack in Kabul is likely,” the White House press secretary, Jen Psaki, said on Friday afternoon. “The threat is ongoing and it is active. Our troops are still in danger.”

attack also killed 13 U.S. service members, and one of the first to be identified was Rylee McCollum, 20, a Marine who had been on his first overseas deployment, according to his father. He was one of 10 Marines, two soldiers, and one Navy medic killed in the attack, according to defense officials.

ISIS-K, instead saying it was just one. The explosion hit right near the airport’s Abbey Gate, at a security chokepoint that squeezed together an enormous crowd that U.S. troops were checking for entry.

It was not only fear that trimmed the crowd at the airport Friday, what had been a constant mass since the Taliban assumed power nearly two weeks ago. Taliban fighters with Kalashnikov rifles kept people farther away from the airport’s entrance gates, guarding checkpoints with trucks and at least one Humvee.

Flights to evacuate people already within the airport resumed soon after the bombing. But the airport itself was largely locked down on Friday.

their origin story and their record as rulers.

Both exercises — the walk and the nudging — are proving to be challenges. In the normally bustling and noisy Shahr-e Naw neighborhood, once alive with street vendors and jostling pedestrians, there is now an unsettling silence. And so far his encounters with the Taliban have not yielded the results he had hoped for.

on pace to fall well short of providing an exit for everyone who wants to leave.

That left Afghans scrambling to find a way out of the country.

In the southwest, thousands of people have been trying to flee into Pakistan, gathering daily near the Spin Boldak-Chaman border crossing, the only one designated for refugees. In the west, several thousand people a day are also crossing into Iran, U.N. officials said.

Daniel Victor, Zia ur-Rehman, Jim Huylebroek, Megan Specia, Fahim Abed, Jack Healy and Helene Cooper contributed reporting.

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Covid Vaccines Produced in Africa Are Being Exported to Europe

Johnson & Johnson’s Covid vaccine was supposed to be one of Africa’s most important weapons against the coronavirus.

The New Jersey-based company agreed to sell enough of its inexpensive single-shot vaccine to eventually inoculate a third of the continent’s residents. And the vaccine would be produced in part by a South African manufacturer, raising hopes that those doses would quickly go to Africans.

That has not happened.

South Africa is still waiting to receive the overwhelming majority of the 31 million vaccine doses it ordered from Johnson & Johnson. It has administered only about two million Johnson & Johnson shots. That is a key reason that fewer than 7 percent of South Africans are fully vaccinated — and that the country was devastated by the Delta variant.

At the same time, Johnson & Johnson has been exporting millions of doses that were bottled and packaged in South Africa for distribution in Europe, according to executives at Johnson & Johnson and the South African manufacturer, Aspen Pharmacare, as well as South African government export records reviewed by The New York Times.

donated by the United States. But about four million of the country’s 60 million residents are fully vaccinated.

That left the population vulnerable when a third wave of cases crested over the country. At times in recent months, scores of Covid-19 patients at Helen Joseph Hospital in Johannesburg were waiting in the emergency department for a bed, and the hospital’s infrastructure struggled to sustain the huge volumes of oxygen being piped into patients’ lungs, said Dr. Jeremy Nel, an infectious-disease doctor there.

“The third wave, in terms of the amount of death we saw, was the most heartbreaking, because it was the most avoidable,” Dr. Nel said. “You see people by the dozens dying, all of whom are eligible for a vaccine and would’ve been among the first to get it.”

a United Nations-backed clearinghouse for vaccines that has fallen behind on deliveries. South Africa was slow to enter negotiations with manufacturers for its own doses. In January, a group of vaccine experts warned that the government’s “lack of foresight” could cause “the greatest man-made failure to protect the population since the AIDS pandemic.”

announced in November. Aspen’s facility in Gqeberha, on South Africa’s southern coast, was the first site in Africa to produce Covid vaccines. (Other companies subsequently announced plans to produce vaccines on the continent.)

South African officials hailed Aspen’s involvement as indispensable.

Aspen “belongs to us as South Africans, and it is making lifesaving vaccines,” South Africa’s president, Cyril Ramaphosa, said during a visit to Aspen’s plant in March. He said he had pushed Johnson & Johnson to prioritize the doses made there for Africans.

“I want them now,” Mr. Ramaphosa added. “I’ve come to fetch our vaccines.”

results of a clinical trial suggested that the vaccine from AstraZeneca offered little protection from mild or moderate infections caused by the Beta variant that was circulating in South Africa.

Weeks later, Johnson & Johnson and the government signed a contract for 11 million doses. South Africa ordered another 20 million doses in April. That would be enough to vaccinate about half the country.

South Africa agreed to pay $10 per dose for the 11 million shots, according to the contract. That was the same price that the United Statespaid and slightly more than the $8.50 that the European Commission agreed to pay. The South African contract prohibited the government from banning exports of the vaccine, citing the need for doses to “move freely across national borders.”

introduced export controls this year to conserve scarce supplies. India halted exports produced by the Serum Institute, which was supposed to be a major vaccine supplier to poor countries. In the United States, officials said they didn’t ban exports, but they didn’t need to. The combination of the extensive vaccine production on American soil and the high prices the U.S. government was willing to pay meant that companies made the delivery of shots for Americans a priority.

Other benefits for Johnson & Johnson were embedded in the South African contract.

While such contracts typically protect companies from lawsuits brought by individuals, this one shielded Johnson & Johnson from suits by a wider range of parties, including the government. It also imposed an unusually high burden on potential litigants to show that any injuries caused by the vaccine were the direct result of company representatives engaging in deliberate misconduct or failing to follow manufacturing best practices.

“The upshot is that you have moved almost all of the risk of something being wrong with the vaccine to the government,” said Sam Halabi, a health law expert at Georgetown University who reviewed sections of the South African contract at the request of The Times.

Mr. Halabi said the contract’s terms appeared more favorable to the pharmaceutical company than other Covid vaccine contracts he had seen. South African officials have said Pfizer, too, sought aggressive legal protections.

The contract said Johnson & Johnson would aim to deliver 2.8 million doses to South Africa by the end of June, another 4.1 million doses by the end of September and another 4.1 million doses by the end of December. (The government expects the 20 million additional doses to be delivered by the end of this year, Mr. Maja said.)

The company has so far fallen far short of those goals. As of the end of June, South Africa had received only about 1.5 million of the doses from its order. The small number of doses that have been delivered to the African Union were on schedule.

The difficulties in procuring doses have revealed the limits of fill-and-finish sites, which leave countries dependent on vaccines from places like the European Union or the United States, said Dr. Salim Abdool Karim, who until March was co-chairman of South Africa’s ministerial advisory committee on Covid.

“Ultimately,” he said, “the solution to our problem has to be in making our own vaccines.”

Lynsey Chutel and Choe Sang-Hun contributed reporting.

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A powerful earthquake violently shakes Haiti. Hundreds are dead.

storm was projected to pass over or near Haiti on Monday, the center said in an update on Saturday afternoon, adding that people on the island should monitor the path of Grace, and that tropical storm warnings for Haiti and other nearby islands could be required later on Saturday or on Sunday.

Over Haiti, the storm could dump four to seven inches of rain, with isolated totals of up to 10 inches, the center said, adding that heavy rainfall could lead to flooding and potential mudslides on Monday and into Tuesday.

Before the center’s afternoon update, Robbie Berg, a hurricane specialist at the center, said the earthquake could increase the chance of mudslides.

“It could have shifted some of the ground and soil, which could make mudslides more common,” he said.

Dennis Feltgen, a spokesman for the center, said the storm was not expected to make landfall in Haiti, which means the center of the storm wouldn’t cross over the island itself.

However, he said, “rain is centered all around the storm, so the center won’t mean a whole lot.”

Grace is expected to strengthen over the next couple of days, and then weaken by Monday or Tuesday, the center said.

Grace, which is the seventh named storm of the 2021 Atlantic hurricane season, follows several days of floods and power outages unleashed this week by Fred.

The Sacred Heart church in Les Cayes was damaged in an earthquake on Saturday.
Credit…Delot Jean/Associated Press

A magnitude-7.2 earthquake struck Haiti on Saturday morning. It was stronger than the magnitude-7.0 earthquake that devastated the Caribbean country in 2010. The United States Geological Survey said the quake struck five miles from the town of Petit Trou de Nippes in the western part of the country, about 80 miles west of Port-au-Prince, the capital. Seismologists said it had a depth of seven miles. It was felt as far away as Jamaica, 200 miles away.

The U.S. Tsunami Warning Center reported a tsunami threat because of Saturday’s earthquake, but later rescinded it.

Aftershocks rippled through the region, the U.S.G.S. said, including one at magnitude 5.1.

More than 300 people were killed and 1,800 injured, according to Jerry Chandler, the director general of the Civil Protection Agency. An untold number of others were missing.

Among the dead was the former mayor of Les Cayes, Gabriel Fortuné, who was killed when the hotel he owned collapsed during the quake, according to a local journalist who knew him, Jude Bonhomme.

Two cities, Les Cayes and Jeremie, located in Haiti’s southern peninsula, have reported major devastation with people caught under rubble and buildings collapsed. Phone lines were down in Petit Trou de Nippes, the epicenter of the quake. No news emerged immediately from that city, leaving Haitian officials to fear for the worst.

The full extent of the damage and casualties is not yet known. But doctors said hospitals were overwhelmed.

A building housing medical students, hospital interns and two doctors had collapsed, trapping those who were most needed to provide aid, said Dr. James Pierre, a surgeon at the general hospital of Les Cayes, also known as the Hospital Immaculée Conception.

The State Department’s internal assessment of the earthquake was bleak. Up to 650,000 people experienced “very strong” tremors with an additional 850,000 affected by “strong shaking,” leaving thousands of buildings at risk of damage and potential, eventual collapse, according to the assessment, shared by a State Department official.

This earthquake could not have come at a worst time for Haiti, which is still recovering from a 7.0 magnitude earthquake in 2010 that killed more than 220,000 people and leveled much of Port-au-Prince. The southern peninsula, where the earthquake hit, is also still recovering from Hurricane Matthew, which hit the country in 2016.

The country of 11 million is also recovering from political turmoil. Haiti has been in the throes of a political crisis since President Jovenel Moïse was assassinated on July 7, and the government is not financially equipped to take care of repairs.

A home in Les Cayes damaged in Saturday’s earthquake.
Credit…Delot Jean/Associated Press

Archdeacon Abiade Lozama of a regional Episcopal Church in Haiti was welcoming teachers and parents to discuss plans to return to school on Saturday when the earthquake struck Les Cayes. Everyone ran outside, looking for an open space free of trees or buildings that could collapse.

He said he walked from the school to the town center and saw only a handful of houses that did not have damage.

“The streets are filled with screaming,” he said. “People are searching, for loved ones or resources, medical help, water.”

Les Cayes was hit hard by Saturday’s earthquake, which came about a month after the assassination of Haiti’s president, Jovenel Moïse, forced the country into a political crisis.

“People are sitting around waiting for word, and there is no word — no word from their family, no word on who will help them,” he said. “When such a catastrophe happens, people wait for word or some sort of confidence from the state. But there’s nothing. No help.”

Archdeacon Lozama had planned for a joyous day to discuss pandemic reopenings but that was derailed.

“Today was supposed to be a day of hope, of meetings with teachers and students to plan for returning to school,” Archdeacon Lozama said.

In Jérémie, another area hit hard by the quake, the collapse of an old cathedral — a Haitian landmark — was a chilling throwback to 2010, when a cathedral in Port-au-Prince, the capital, was destroyed during an earthquake that has scarred the nation since.

That cathedral, which has yet to be restored, is a symbol of the many devastations the country has faced and of the government’s inability to help its own population, one of the most destitute in the world.

The main supermarket in Les Cayes collapsed, leaving the population of about half a million with dwindling supplies and worries that eventually there would be looting and fighting over basics like drinking water. The local hospitals — already underfunded — were overwhelmed with casualties.

The magnitude-7.2 quake snapped the underground pipes of Les Cayes, flooding the streets.

Dr. Fatima Geralde Joseph said she tried to rush over to the clinic where she works to start helping, but she could not cross the flooded streets and eventually had to return home.

Others interviewed said there were aftershocks as strong as magnitude 5.2 every 10 minutes, setting off panic among the population.

Damage caused by the earthquake on Saturday.
Credit…Ralph Tedy Erol/EPA, via Shutterstock

When Gepsie Metellus got the news from a cousin on Saturday morning that a powerful earthquake had rocked Haiti, she made a panicked call from her home in Miami to her husband, who had traveled to Port-au-Prince on Thursday for a visit.

As she dialed his number, her thoughts returned in terror to the 7.0-magnitude earthquake that devastated Haiti 11 years ago.

“It’s taking me back to visions of 2010,” said Ms. Metellus, executive director of Sant La, a Haitian neighborhood center in Miami. “We’re just bracing ourselves, just bracing ourselves for really terrible news.”

She was able to contact her husband, who was safe, but for some, the agony of not knowing the fate of their loved ones continued through the day.

Members of the Haitian diaspora in the United States spoke on Saturday of making anxious calls to relatives and friends in the Caribbean nation, and U.S.-based aid organizations were struggling to assess the scope of the damage and to connect with their people on the ground.

“All circuits are busy — circuits are really, really overwhelmed right now,” said Elizabeth Campa, an adviser with Zanmi Lasante, a health care provider in Haiti, and a sister organization of the Boston-based organization Partners in Health.

“We are still trying to desperately get a hold of the staff,” said Skyler Badenoch, chief executive of Hope for Haiti, a U.S.-based organization that works to reduce poverty in Haiti. By Saturday afternoon, the organization had been able to account for 45 of its 60 staff members in Haiti. Of those who reported themselves safe, many had experienced major damage to their homes.

Commissioner Jean Monestime of Miami-Dade County said he had fielded calls all day from constituents desperately trying to reach family members in Haiti.

“People are still in disbelief that Haiti is experiencing yet another disaster,” he said, adding that he and other Haitian American elected officials were working to organize response efforts.

“What the assessment has been so far in terms of casualty and the effort for search and rescue — there’s not much that we are learning as of yet,” Mr. Monestime said.

For those watching anxiously from the U.S., the political turbulence in the weeks following the assassination of President Jovenel Moïse of Haiti raised additional concerns about the prospect of recovery from Saturday’s earthquake.

“All this against the backdrop of a country where gangs are running amok, a country with no functioning government,” said Ms. Metellus, adding, “Everyone’s feeling this collective sense of anxiety, of frustration, of fear, of déjà vu.”

A damaged building in Les Cayes on Saturday.
Credit…Delot Jean/Associated Press

With phone lines down and roadways disrupted or gang-controlled, news organizations and emergency officials scrambled to try to gain access to the parts of Haiti damaged by a powerful earthquake on Saturday morning. Port-au-Prince, the capital, is 80 miles west from the quake’s epicenter, near Les Cayes — and some four and half hours away by car.

The flight time from Port-au-Prince to Les Cayes is only 30 minutes. News services like The Associated Press tried to get reporters on medical or charter flights to document the state of the stricken region.

News photographs and reports began filtering through by Saturday afternoon, but in the interim, social media became a pivotal source of information about the earthquake’s devastation, supplying images and videos.

One video being picked up by multiple reporters and media outlets online shows the destruction of multiple houses and buildings as people try to help those that might be caught under the rubble.

The posts show people still in their pajamas or bath towels, out in the street seeking safety after fleeing violently trembling homes. Entire three-story buildings were flattened to eye-level. One video showed a group of men sifting through rubble to try to extract someone buried beneath.

This is not the first time that social media has filled an urgent news role in the Caribbean. Climate change has caused stronger storms and hurricanes that hit the area with more force, and suffering and paralyzing hits to infrastructure often hit social media first.

Social media platforms also have sometimes served as a communications network, where families could connect with loved ones when phone lines went down and learn about relief efforts, according to reporting from The Pulitzer Center.

That was true during Hurricane Maria in 2017 and also in 2010, when a 7.0 magnitude earthquake struck Haiti, killing more than 220,000 people.

A building in Les Cayes damaged in Saturday’s earthquake.
Credit…Ralph Tedy Erol/EPA, via Shutterstock

Hours after the earthquake hit Haiti, the Biden administration, the United Nations and private relief agencies that operate in Haiti promised urgent help.

President Joe Biden and Vice President Kamala Harris received a briefing on Saturday morning about the Haiti earthquake while they were at a meeting discussing Afghanistan, according to the White House. The president authorized an immediate response, The Associated Press reported, and named the USAID administrator, Samantha Power, as the senior official coordinating the effort.

Ms. Power said in a Twitter post that USAID was “moving urgently to respond” and that experts were on the ground assessing damage and needs. In a tweet, the United Nations secretary-general, António Guterres, said that the U.N. “is working to support rescue and relief efforts.” There was no outline of what the responses might look like as damage on the ground continues to be evaluated and the death toll continues to rise.

“While it will take days to assess the full scale of the damage, it is clear that this is a massive humanitarian emergency,” said Leila Bourahla, Save the Children’s Haiti country director. “We must respond quickly and decisively.”

UNICEF, a branch of the U.N., said in a statement that it was working with government and non-goverment organizations to evaluate what was needed. The agency said it has offices in the south of Haiti and staff members on the ground were making assessments in order to prioritize urgent needs and provide assistance to affected populations. Much of the assistance right now seems to be medical.

Nonprofit organizations like Community Organized Relief Effort, or CORE, which was founded by Sean Penn in 2010 after another earthquake hit Haiti, are also on the ground. CORE deployed two teams Saturday, one of which is a mobile medical team, according to a statement from the organization.

But getting aid to those who need it in Haiti isn’t easy. An influx of foreign aid and peacekeeping forces after the 2010 earthquake appeared to only worsen the country’s woes and instability. The international community has pumped $13 billion of aid into the country over the last decade, and instead of the nation-building the money was supposed to achieve, Haiti’s institutions have become further hollowed out in recent years.

The aid has propped up the country and its leaders, providing vital services and supplies in a country that has desperately needed vast amounts of humanitarian assistance. But it has also left the government with few incentives to carry out the institutional reforms necessary to rebuild the country, allowing corruption, violence and political paralysis to go unchecked.

A home damaged by an earthquake in Les Cayes on Saturday.
Credit…Delot Jean/Associated Press

After a powerful earthquake hit Haiti early Saturday, the U.S. Tsunami Warning Center initially reported a tsunami threat and warned of waves between three to 10 feet high.

The threat was then rescinded.

A video circulating on social media showed residents of Les Cayes fleeing a flooded street, splashing through murky, knee-deep water, but it wasn’t clear what caused the flooding.

Earthquakes with a magnitude between 6.5 and 7.5 generally do not produce deadly tsunamis, but they can cause a small sea change level close to a quake’s epicenter, according to the United States Geological Survey.

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Tunisia’s Democracy Verges on Collapse as President Moves to Take Control

CAIRO — Tunisia’s fledgling democracy, the only one remaining from the popular revolutions that swept the Arab world a decade ago, trembled on the brink of collapse Monday after its president sought to seize power from the rest of the government in what his political opponents denounced as a coup.

The president, Kais Saied, who announced the power grab late Sunday, did not appear to have completely succeeded in taking control as of Monday evening, as chaos enveloped the North African country. But many Tunisians expressed support for him and even jubilation over his actions, frustrated with an economy that never seemed to improve and a pandemic that has battered hospitals in recent weeks.

With Syria, Yemen and Libya undone by civil war, Egypt’s attempt at democracy crushed by a counterrevolution and protests in the Gulf States quickly extinguished, Tunisia was the only country to emerge from the Arab Spring revolutions with a democracy, if a fragile one.

But the nation where the uprisings began now finds even the remnants of its revolutionary ideals in doubt, posing a major test for the Biden administration’s commitment to democratic principles abroad.

statement. Secretary of State Antony J. Blinken, in a phone call Monday with Mr. Saied, encouraged him “to adhere to the principles of democracy and human rights,” a spokesman said.

Defying the Tunisian president, the prime minister, Hichem Mechichi, said he would hold a cabinet meeting even after Mr. Saied announced the dismissal of him and several ministers. Parts of Parliament said they would meet virtually even as soldiers cordoned off the Parliament building.

But the danger remained that Mr. Saied would back up his power grab with greater force, whether by further deploying the military or arresting top officials.

“This is a very concerning development that puts the democracy at great risk of unraveling,” said Safwan M. Masri, executive vice president of Columbia University’s Global Centers network, who studies Tunisia. Referring to Mr. Saied, he said: “An optimistic scenario would be that the Parliament and the Constitution and democratic institutions would prevail and that he would be forced out of office. But I would not bet any money on it.”

Already, the president has announced that he was assuming the public prosecutor’s powers and stripping lawmakers of immunity.

whether the revolution was worth it.

Protests and strikes frequently racked the country, and popular discontent widened the gap between elites who praised Tunisia’s democratic gains and Tunisians who simply wanted to improve their lot.

The coronavirus pandemic made things worse by devastating Tunisia’s tourist industry, an important economic engine. The virus has shaken the government and the health system even further in recent weeks as Tunisians have died of Covid-19 at the highest rate in the Middle East and Africa.

On Sunday, demonstrators across Tunisia called for the dissolution of Parliament, giving Mr. Saied some popular cover to announce that night that he was firing Mr. Mechichi, freezing Parliament for 30 days and assuming executive authority.

Tarek Megerisi, a senior fellow at the European Council on Foreign Relations. “They blame them for all the country’s problems and think that they need to be removed.”

The showdown was a long time coming, with Mr. Saied locked since his election in political infighting with Mr. Mechichi and the speaker of Parliament, Rachid Ghannouchi.

Mr. Saied has been hinting for months at expanding his authority by refusing to swear in ministers and blocking formation of a constitutional court, raising alarm among opponents and political analysts.

In response to chaos in Tunisia’s Covid-19 vaccination rollout last week and a surge in cases that has overwhelmed hospitals, Mr. Saied stripped control of Tunisia’s coronavirus response from the Health Ministry and handed it to the military.

On Sunday night, Mr. Saied cited Article 80 of the Constitution, which he said permits the president exceptional powers. He said he had consulted both Mr. Mechichi and Mr. Ghannouchi and held an emergency meeting with other officials before acting.

Mr. Saied said he was doing so to preserve the country’s “security and independence and to protect the normal operation of state institutions.”

Article 80, however, accords the president such powers only if the country faces an imminent threat and only after the prime minister and parliament speaker have been consulted. Mr. Ghannouchi denied that he had been.

In a statement, Mr. Ghannouchi deplored what he called a “coup” and described the suspension of Parliament as “unconstitutional, illegal and invalid.” The assembly “remains in place and will fulfill its duty,” he said.

In a televised statement, Mr. Saied said, “This is not a suspension of the Constitution.” And he sounded an ominous warning to adversaries: “Whoever fires a single bullet, our armed and security forces will retaliate with a barrage of bullets.”

Videos posted to social media showed crowds cheering, honking, ululating and waving Tunisian flags after the president’s actions Sunday night, the dark night lit up by red flares. Other videos showed Mr. Saied wending through cheering supporters along the main thoroughfare of Tunis, where revolutionaries gathered during the 2011 protests.

The next step for Tunisia is unclear. The country has so far failed to form the constitutional court, called for in the 2014 Constitution, that could adjudicate such disputes.

In his statement, Mr. Saied said cryptically that a decree would soon be issued “regulating these exceptional measures that the circumstances have dictated.” Those measures, he said, “will be lifted when those circumstances change.” He also fired the defense minister and acting justice minister on Monday afternoon.

Tunisia’s divisions reflect a wider split in the Middle East between regional powers that supported the Arab revolutions and the political Islamist groups that came to power at the time (Turkey and Qatar), and those that countered the uprisings (Saudi Arabia, the United Arab Emirates and Egypt). While Turkey and Qatar expressed concern on Monday, the others remained quiet.

Reporting was contributed by Nada Rashwan from Cairo, Lilia Blaise and Massinissa Benlakehal from Tunis, and Michael Crowley from Washington.

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Heavy Floods in China Trapped Passengers in Subway, Killing 12

The subway train in Zhengzhou, a city of five million in central China, was approaching its next station when the floodwaters began to rise ominously on the tracks. The passengers crowded forward as the water rose, submerging the cars at the rear first because they were deeper in the tunnel.

As the water reached their waists, then chests, finally their necks, the passengers called emergency services or relatives. One gave her parents the details for accessing her bank account. Some cried. Others retched or fainted. After two hours, it became difficult to breathe in the congested air that remained in the cars.

Ding Xiaopei, a radio host, was afraid to call her children, 13 and 4. What could she say? She posted a video that she thought might be her last message. “The water outside has reached this position,” she said, it having reached chest level, “and my mobile phone will soon run out of power.”

“Please save us!” she wrote.

The flood that inundated Line 5 of Zhengzhou’s subway on Tuesday added to the grim global toll extreme weather has taken already this year, with scorching heat in the Pacific Northwest, forest fires in Siberia, and flooding in Germany and Belgium. Although flooding is common in China, researchers have attributed the extreme weather sweeping the planet to the consequences of climate change.

reported. At least one carrying 735 people came to a stop near Zhengzhou and, after more than 40 hours, had run out of food and water. By the afternoon, some passengers were able to leave, while railway workers brought supplies to those still waiting aboard for service to resume.

battled weeks of flooding along the Yangtze River that killed hundreds of people and displaced millions more. The rains at that time filled the Three Gorges Dam to its highest level since it opened in 2003, raising fears that the dam itself could fail.

The government often goes to great lengths to manage information about disasters, sensitive about its history of underreporting casualties. It is quick to limit news coverage and censor blogs and social media sites to mute public dissatisfaction with prevention and rescue efforts.

Some people on Chinese chat platforms and social media sites have raised questions about whether official news outlets in Zhengzhou and Henan Province initially downplayed the flood. When storms struck Beijing recently, the authorities warned people to stay home, but there was no order to shut businesses or schools in Zhengzhou ahead of Tuesday’s heavy rain.

In times of disaster, the country’s state news media often focuses on the efforts of rescue workers, including the military, while playing down the causes of disasters and their damage. A journalism professor, Zhan Jiang, posted a note on Weibo, the social media platform, on Tuesday complaining that a television station in Henan Province continued to show its regular programming instead of providing public safety information.

the news site Jiemian, part of the state-owned Shanghai United Media Group.

By 8:35 p.m., rescuers reached the train and devised a pulley system with ropes to help passengers pull themselves through the floodwaters along a ledge in the subway tunnel. The elderly and injured went first, followed by the women and then the men. State news organizations said that 500 people were evacuated in all.

One man still missing was Sha Tao. When the subway car first flooded, he called his wife and asked her to call the police. She has not heard from him since. She posted a message on Weibo asking people for help, describing his height and weight and the clothes he was wearing.

“I haven’t found him yet,” she said when reached by telephone in Zhengzhou on Wednesday. “I went to several hospitals, but the hospitals didn’t have any information and couldn’t find him. His phone is now off.”

Amy Chang Chien, Claire Fu, Li You, Liu Yi and Albee Zhang contributed research.

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