**9. Conclusions**

Hurricane Maria left a lot of damage in its wake. Female-headed households were impacted from psychological, social, educational and spiritual points of view. This study aimed to find out what happened immediately after the passing of the hurricane and four years later. There were improvements; however, COVID-19 impacted the trajectory of improvements in a negative manner. Female-headed households are still grappling with the after-effects in those four spheres and require the intervention of the government at the macro level. Unmet needs and psychological distress were main themes that emerged from the findings. Interventions entail ensuring that households are more resilient to disasters, an expanded safety net to help households move above the poverty line, higher income earning capacity, focus on climate resilience livelihoods, improved telecommunication systems and education and training for single and unemployed women. Emphasis on psychosocial support to assist with anxiety, fear and other distressing emotions linked to Hurricane Maria is needed today.

**Funding:** This research received funding from The Caribbean Disaster Emergency Management Agency (CEDEMA) as winner of the "Jeremy Collymore Award for Research in Humanitarian Response and Disaster Risk Management" in 2019.

**Acknowledgments:** I would like to thank CEDEMA who funded this research based on me being the winner of the 2019 Jeremy Collymore Award for Research in Humanitarian Response and Disaster Risk Management. I would also like to thank the participants who took part in the research for sharing their lives with us and finally the research assistants who assisted in data collection in the midst of the COVI-19 Pandemic.

**Conflicts of Interest:** The author declares no conflict of interest.
