medical library in the country. It had to be evacuated because all of its 25 buildings suffered severe damage. Most of the beds that it lost were dedicated to tertiary, high-technology care. The ISSSTE hospital for government workers lost 36 percent of its capacity. The 2,158 beds of the Ministry of Health (SSA) were lost, representing 43 percent of its capacity in the city. This included the 700 beds lost with the complete collapse of Juárez Hospital and the gynecology-obstetrics tower of the General Hospital of Mexico. In total, the city lost more than 4,000 public hospital beds in the earthquake, severely disrupting these institutions' ability to handle the crisis. In addition, five of the largest private hospitals had to be evacuated. More than 900 patients, physicians, nurses and paramedical workers died in the initial shock. In contrast, the network of twenty four community general hospitals with 1,600 beds belonging to the city (federal district) were not affected as these were spread out beyond the city center and the old lakebed. Outside Mexico City Although much closer to the epicenter, the states of Jalisco, Colima, Guerrero and Michoacán suffered only mild to moderate damage. Landslides caused damage at Atenquique, Jalisco, and near Jala, Nayarit. Rockslides were reported along highways near Ixtapa, Guerrero, with sand volcanos and ground cracks in Lázaro Cárdenas. Students at the Universidad de las Américas in nearby Puebla reported feeling as if the cafeteria had been lifted and rocked back and forth, shattering windows and injuring some people but mostly causing panic. A small tsunami caused only mild damage to Lázaro Cárdenas and Zihuatanejo. Some fishing boats were reported missing but these reports were never confirmed. One exceptional case was in Ciudad Guzmán, Jalisco, where about 60 percent of the buildings were destroyed, with about 50 dead. Some damage also occurred as far away as the states of Mexico, Morelos and parts of Veracruz, on the Gulf coast. Coastal and most inland damage was moderated by the fact that most of the west of Mexico sits on bedrock, which serves to transmit the shockwaves without amplifying them. La Villita, and Infiernillo Dams, near the coast, were superficially damaged and undamaged respectively. Off the coasts of Michoacán and Guerrero, the 19 and 20 September events caused a rupture in the seabed 240 km long and 70 km wide, located between the subduction trench and the coastline. This is