COVID-19 was devastating for Arkansas' sizable Marshallese community, especially in the Northwest region of the state. The virus spread quickly through the area, where many Marshallese moved to work in poultry plants, which never closed during the pandemic. Pacific Islanders make up at most 3% of the region's population, but they accounted for 20% of the region's COVID-19 cases from March to June of 2020, according to the CDC. In that same period, they accounted for 38% of the region's COVID-19 deaths.

This is due in part to the high incidence of diabetes in the Marshallese — which itself can be traced back to the legacy of colonization and United States nuclear testing in their home country, Marshallese say.

"If you survey every household, there might be one or two who have diabetes, or other health problems," said Albious Latior, a Marshallese community advocate in Springdale, Arkansas, at a commemoration of the 75th anniversary of the testing earlier this month. The three-day series of events centered on the health impacts of the nuclear legacy and was hosted by the nonprofit Marshallese Educational Initiative, based in Springdale, which is home to about 15,000 Marshallese. It also included programming specifically for Marshallese youth. 

While the direct health effects of radiation exposure are well-known — radiation illness, burns, thyroid cancers, birth defects — nuclear testing carried out in the Pacific Island nation by the United States following World War II also indirectly impacted the health of the Marshallese by displacing hundreds from their home atolls and contaminating the soil and water. This resulted in replacing their traditional diet heavy on seafood and indigenous fruits with imported canned goods and other preserved foods — in part to blame for chronic health conditions like diabetes.

"If you talk to our elders, our grandparents, our great-grandparents, they always talk about how unique back then was. They ate their own food, grew their own food," said Latior. "But when there was nuclear testing, everything changed. The U.S. provided canned food to the Marshallese and said this is healthy for you."

All Marshallese are impacted, directly or indirectly, by the nuclear testing, said Sheldon Riklon, the only Marshallese doctor in Arkansas. "The program ended, but not the devastation," Riklon said. "Not the environmental impact on the islands. Not the radiation contamination of our beautiful islands, our lands, our beautiful pristine lagoons. Not the long-term health effects on our families that continue until today, 75 years later."

In all, the U.S. detonated 67 weapons in the Marshall Islands and atolls over the course of a dozen years. Following Castle Bravo, the largest nuclear weapon ever detonated by the U.S. at 15 megatons, hundreds of Marshallese people in the fallout zone were made part of Project 4.1, a U.S. government study that studied the impact of radiation on human beings without the Marshallese subjects' knowledge or consent.

Declassified U.S. files show that radioactive fallout impacted not just the atolls where the weapons were detonated but spread throughout the islands. But for years, the U.S. claimed that radioactive fallout from the Castle Bravo test impacted only four atolls — a myth that persists in the Marshallese community to this day. "The U.S. needs to admit that this is not only the four atolls, but all the Marshall Islands. And they need to clean up what they did to our people, and to our land," said Latior.

"This whole 'four atolls' thing was constructed by the U.S.," said Ariana Tibon, the education specialist at the Republic of the Marshall Islands (RMI) National Nuclear Commission. She and other panelists encouraged Marshallese from every atoll to learn and talk about the impact of the nuclear legacy on themselves and their families.

"The main thing I have heard repeated is the need to share our story," said Benetick Maddison, the nuclear and climate specialist at MEI. Because the U.S. classified so much of the material related to the nuclear tests and hid the existence of Project 4.1 from the test subjects for decades, many Marshallese people are unaware of the extent of the testing or its impact. And many Americans have no idea the nuclear testing happened at all.

Meanwhile, Marshallese people from every atoll, including those who have relocated to Hawai'i and the continental U.S., continue to suffer health problems related to the tests that persist to this day.

An interconnected struggle

The three days of programming around the 75th anniversary of the tests focused on the core issues of the nuclear legacy that have led to health inequities, as well as the impact of the deepening climate crisis on the Marshallese and the islands. Though the radiation and its fallout have led to high cancer rates, there is no cancer care center on the islands. Many Marshallese move to Hawai'i or the mainland U.S. to seek health care.

The speakers on the panels emphasized the interconnectedness of the triple challenges of nuclear legacy, climate change, and health.

"All my friends are on the climate change wagon," said Tibon of the National Nuclear Commission. "But they have cancer in their families too … Cancer is not from climate change. Cancer is from the nuclear testing."

Marshallese people can move to the U.S. under a Compact of Free Association first negotiated in the 1980s. Under the original terms of the agreement, they were eligible for government health insurance programs including Medicaid — eligibility that was revoked under the welfare reform act of the 1990s. Despite decades of advocacy, their Medicaid eligibility was not restored until the December CARES Act, after the COVID-19 pandemic pushed the issue into the spotlight.

Tina Stege, the climate envoy for the Marshall Islands, noted that the climate crisis is also a health crisis. Before COVID-19, the country was dealing with an outbreak of dengue — a mosquito-borne viral disease — that forced border closures. Dengue, a disease that many experts anticipate will become more prevalent as the climate warms, strained the country's limited health care infrastructure.

"We had eight disease outbreaks last year, this is something we haven't seen before," Jack Niedenthal, the Marshall Islands health secretary, said at the time. "It's so unusual for us to see these things, what else could it be? This is directly related to climate change."

The U.S. and the United Nations owe some form of reparations to the Marshall Islands, panelists said. That responsibility begins with education, said Tibon, but it doesn't end there. There needs to be a cancer care center, and the Department of Energy-funded health programs for nuclear victims on the island need to be more expansive and better funded.

The RMI is currently renegotiating the terms of the Compact of Free Association with the U.S. As it currently exists, said Maddison of MEI, the compact is "an unfair policy that has done little and provides inadequate reparations." He wants the new version to address the impact of the nuclear legacy for all those affected, not just those on the four atolls. He and others are also calling on the U.S. to invest in cleaning up the Runit Dome, where tons of radioactive waste are stored; it has serious structural issues and is leaking waste into the environment.

For the Marshallese who have moved to the U.S., there needs to be a concerted effort to make health care accessible and affordable for a community whose health problems result in part from decades of U.S. policy, many of the event's speakers said. While Marshallese people are now eligible for Medicaid, eligibility isn't the same as accessibility. People who have grown used to avoiding trips to the doctor because they lacked health insurance will now have to navigate the U.S. health care system across language barriers.

"We will continue to be contributing members of the communities we reside in as long as we are afforded the opportunity to be healthy community members," Dr. Riklon said. "It is our duty as victims and survivors to not let it happen again. Ever."