Appendix C

Summary of Virtual Listening Sessions and Community Meetings

The committee engaged with community members to support information-gathering phases of the study process through several virtual and in-person listening sessions. A series of three virtual listening sessions were held between April and May 2025, and two town hall sessions were conducted in person at the O‘ahu Veteran’s Center in Honolulu, Hawai‘i, in June 2025.

The following appendix summarizes the discussions from these community listening sessions. The statements made are those of the rapporteur or individual meeting participants and do not necessarily represent the views of all participants, the study committee, or the National Academies of Sciences, Engineering, and Medicine.

OVERVIEW OF COMMUNITY LISTENING SESSIONS

As noted in Chapter 1, the committee hosted several community listening sessions to gather insights on the experiences and perspectives of those exposed to or affected by the jet propellant 5 (JP-5) releases at Red Hill. Virtual listening sessions, held between April and May 2025, focused on community experiences with public health and health care services, mental health, and pediatric health. Each 90-minute session was moderated by committee members and posed questions to listening session participants on the public health response, impacts on mental health, symptoms and experiences of children, experiences with receiving or providing medical or mental health care, and experiences accessing pediatric care following the November 2021 fuel release.

On June 25, 2025, the committee hosted two world café–style community meetings in Honolulu, Hawai‘i, based on a facilitated small group dialogue model, intending to surface shared wisdom through open, role-based conversation. Participants were asked to self-assign to a small group for the entire session, based on their perspective (e.g., military-affiliated exposed resident, civilian military employee, non-base resident, health care provider, public health responder, community advocate). Small group discussions were conducted for 90 minutes, followed by a full group report-back.

Individuals were invited to participate in virtual and in-person community listening sessions through a public, online registration page. Invitations to register for the listening sessions were widely advertised through the National Academies website, Red Hill community groups, local radio, and word of mouth through community liaisons. No restrictions were placed on participation or group assignments.

Summary of Virtual Listening Sessions

Experiences of the Public Health Response

Incident Communication and Awareness

Several participants felt that they first learned about the contamination through personal observation, or informal channels such as neighbors, social media, and news coverage rather than through direct official messaging:

• “When I first heard about it, it was through Facebook with other spouses that were complaining of the same foul odor that I was having in my house. And then the night before, Spitzer held up the glass of water on Facebook. It seems like Facebook was a big media outlet for the families.” (Public Health and Health Care Services Session participant)
• “First, I started hearing people talk in Facebook spouse groups, and I had no idea that there was anything happening that could be impacting us. When I heard the stories on Facebook in the different spouse groups, I was shocked and, also like, how is this possible that we are not hearing anything about it?” (Public Health and Health Care Services Session participant)
• “I had found the yellow ice that smelled and felt of jet fuel in my ice maker.” (Public Health and Health Care Services Session participant)
• “We noticed the smell in our kitchen on Sunday night . . . it smelled like fuel.” (Public Health and Health Care Services Session participant)

• “I did not know to smell it until I looked at my neighborhood Facebook page. They said something is weird with the water. It smells like fuel. I thought that is insane. I smelled it and my water smelled like a gas station.” (Public Health and Health Care Services Session participant)
• “When this all started with Facebook and Kapilina page where we live, Kapilina Beach Homes, the Navy denied it. They said oh no. You are not on Navy Water. And we said, yes, we are on Navy Water. Our bill goes to Navy Water.” (Public Health and Health Care Services Session participant)
• “It was at least 10 days after that we realized something was not right. My whole family was experiencing various symptoms. And then I went on the Facebook page. And others had been going to the hospital and had been very sick. That is how we found out.” (Public Health and Health Care Services Session participant)
• “We had heard rumors on Facebook that something was going on. We noticed the smell Sunday night, and we made the decision that we were not going to use the water.” (Public Health and Health Care Services Session participant)
• “On Tuesday, I went to a Bible study and ran into several friends who do not do Facebook, who had no idea what was going on.” (Public Health and Health Care Services Session participant)
• “But at this time, we were still in the height of COVID and people’s sense of smell was questionable. To rely on that alone was really not the way to go in my mind. A lot of people did not get that information very clearly and it felt very uncoordinated with the Navy itself.” (Public Health and Health Care Services Session participant)

Listening session participants also noted that information about the spill was communicated at different times, and communication shifted over time, which left individuals uncertain about what guidance to follow:

• “I started attending the town halls. . . . On Monday, they were saying there is no spill. There was never a spill. By Thursday, they said, we knew there was a spill. In fact, we shut the water off on Sunday. That told me I had been lied to.” (Public Health and Health Care Services Session participant)
• “I remember calling the school and saying do not allow my children to drink the water at that school. And the school had already been informed, which is interesting. The school was informed, but we were not.” (Public Health and Health Care Services Session participant)
• “We lived in former Navy housing and were not told for 6 to 8 weeks that our neighborhood was still on the water line and could

• have been affected.” (Public Health and Health Care Services Session participant)
• “We got very little public health information. And the question is, do we trust the advisories? No, I do not.” (Public Health and Health Care Services Session participant)
• “An email from December 9 says that Kapilina is not listed on affected areas [in a] blanket recommendation to all consumers to not consume or use water. We heard this term out of an abundance of caution. . . . It [the water] is fine, but you might not want to use it [the water].” (Public Health and Health Care Services Session participant)
• “From the HDOH [Hawai‘i State Department of Health], we were ultimately told, if it does not smell, and it does not have a sheen, then you are probably okay. That was not true. I ended up getting very sick from the water that I had stored in my fridge. I drank it over the week. After that town hall, I ended up going to the ER [emergency room]. I was very sick.” (Public Health and Health Care Services Session participant)

Perceptions of Response Effectiveness and Coordination

Some participants reflected that interagency responses varied, with certain branches moving quickly to relocate families and offer services, while others were slower to act. Several participants drew comparisons to natural disaster responses, suggesting that a similar approach might have offered more coordinated communication and response.

• “Some families were moved into hotels quickly with organized laundry and transportation services, but others were left waiting without clear instructions. The level of support really depended on which agency you were dealing with.” (Public Health and Health Care Services Session participant)
• “It felt like the Army and Navy were not responding in the same way. One branch seemed to move faster to get families out, while the other dragged its feet.” (Public Health and Health Care Services Session participant)
• “If this was a natural disaster, if it was a hurricane, help would have come immediately. We did not get help for weeks. We had to beg for help. We had to convince people we needed help.” (Mental Health Session participant)
• If this had been a national disaster, a hurricane, an earthquake, FEMA [the Federal Emergency Management Agency] would have

• come in. It would have been labeled a national disaster. You get therapists on the ground to help people. You get proper messages across the board and people show up. And then it is a real thing. It is on the news. The nation knows, and then it is respected and treated as that thing. None of that happened for any of us.” (Mental Health Session participant)
• “A disaster-level response similar to FEMA should have been triggered. That type of structure would have provided consistent support and removed the burden from families to act as their own advocates.” (Public Health and Health Care Services Session participant)
• “I was calling for the CDC [U.S. Centers for Disease Control and Prevention] to be notified. I never understood why there was not a national emergency declared. . . . In the future, I would love to see more transparency and more truth and more of the agencies getting involved and national emergencies declared because families are still suffering.” (Public Health and Health Care Services Session participant)

Participants recalled questioning testing and remediation efforts, noting that advisories were at times confusing or conflicting with their personal observations:

• “Somebody from the Naval Housing Authority was on my front lawn over the sewer grate, appeared to be taking an air sample reader. They had a device in their hand. She said she was there examining a tree that fell three weeks prior and they had already removed and cleaned up. I knew that was not true.” (Public Health and Health Care Services Session participant)
• “When they flushed our homes, the whole house filled with volatile chemicals. Even our pets got sick from it.” (Public Health and Health Care Services Session participant)
• “During this time, the Navy was flushing that contaminated water onto the known pesticide-contaminated soil. A lot of these symptoms we were having were like [we] were exposed to pesticides. We know they [pesticides] were in the soil, and we know that they [the Navy] flushed the enormous amount of contaminated water onto the soil until the HDOH came out and told them they [the Navy] could no longer do that.” (Public Health and Health Care Services Session participant)

Perceptions of Risk

Participants described being cautious with water use, even long after advisories were lifted. Families spoke about avoiding drinking, cooking, and bathing with tap water, reflecting a sense of lingering vulnerability. For some, even cleaning or brushing teeth with tap water felt unsafe, which shaped their daily routines and household practices:

• “At Hale Keiki School, they had to scramble to set up external handwashing stations with bottled water. When the all-clear came in March, we had to sign whether we thought it was safe for our children to use tap water again. My kids never went back to using reusable bottles…from then on, we only used disposable bottles washed with bottled water. It was incredibly strange behavior for us as parents.” (Pediatric Health Session participant)
• “One of the problems we ran into was getting the kids to stop using tap water to brush their teeth. My 4-year-old accidentally brushed with tap water and came to me apologizing, asking for a new toothbrush. We eventually had to tape over the sinks. We also stopped giving baths, threw away their bath toys, and didn’t let them play outside because of the risks.” (Pediatric Health Session participant)
• “During the early days we felt it was imperative to remove the immediate danger from the children’s lives, which unfortunately meant no tap water. We built homemade bottled water setups in the bathrooms so they could wash their hands, and the routines they had known since early childhood had to be completely redirected.” (Pediatric Health Session participant)
• “We noticed the smell in our kitchen on Sunday night, just days after the spill, and immediately decided not to use the water. I went to Walmart the next day for bottled water, and they were already rationing it. My kids and husband switched entirely to bottled water, but I kept drinking water from the reverse osmosis machine at the gas station, not realizing it was tap water, and I became very sick.” (Public Health and Health Care Services Session participant)
• “There was an extended period when we could not meet our basic needs. Stores put limits on water purchases. Camp showers sold out. I lost ten pounds that first week because I couldn’t figure out how to eat or cook safely. We didn’t know where it was safe. . . . Even showers on base turned out not to be safe.” (Mental Health Session participant)
• “Months later, our teenage son told an aunt that he didn’t want to drink her water and asked for bottled water instead. We had never

• spoken to him about it, but he carried that fear in him.” (Mental Health Session participant)

Some individuals described community-driven strategies to reduce use of contaminated water during the incident:

• “Families organized their own water setups in the bathrooms with bottled water so the kids could wash their hands. It became a kind of community practice, everyone helping each other figure out how to get through the daily routines without tap water.” (Pediatric Health Session participant)
• “When the stores started rationing water, neighbors shared what they had with each other, and some of us went to different Walmarts or commissaries to bring water back for the whole group.” (Public Health and Health Care Services Session participant)

Discussions on Health Impacts

Participants described health concerns that were both immediate and long-lasting. For example, individuals described experiencing acute symptoms such as rashes, migraines, gastrointestinal (GI) distress, and palpitations following exposure to contaminated water, with some reporting chronic conditions including neuropathy or persistent skin disease. Children were frequently reported as the most affected, with symptoms such as asthma, rashes, GI upset, and (in some cases) rare conditions requiring hospitalization. Listening session participants also emphasized concerns of mental health impacts for children, including anxiety, depression, mood instability, and self-harm, which often overlapped with physical symptoms. Adults similarly reported stress, anxiety, and trauma, particularly among parents caring for ill children, compounded at times by stigma around mental health.

Quotes on Adult Physical Symptoms

Adults shared accounts of immediate health changes after exposure. These included rashes, migraines, GI discomfort, eye irritation, and episodes of dizziness or heart palpitations. For some, symptoms were disruptive to work and family life. Participants also expressed concern that chronic conditions such as neuropathy, reproductive changes, or cancer risks might be connected to long-term exposure, although they acknowledged uncertainties remain:

• “I ended up in urgent care with boils that almost made me septic, and later I was diagnosed with hidradenitis suppurativa. I had

• never experienced anything like this before the water crisis.” (Mental Health Session participant)
• “I experienced heart palpitations and spiraling episodes that left me feeling like something bad was always about to happen, even when I was just sitting at home.” (Mental Health Session participant)

Quotes on Adult Mental Health Impacts

Adults described stress, anxiety, and trauma that persisted well beyond the immediate incident. Some participants linked their symptoms to postpartum stressors, existing mental health vulnerabilities, or the strain of caring for sick children. Others spoke about feelings of discouragement, helplessness, or institutional betrayal during the incident:

• “I developed postpartum depression and anxiety after my newborn suffered chemical burns. I could not tell if what I was feeling was normal postpartum stress or if it was related to everything going on with the water.” (Mental Health Session participant)
• “I felt betrayed by the way everything was handled. It was as if my entire hierarchy of needs had exploded, and I was left trying to piece together basic safety for my family.” (Mental Health Session participant)
• “I often felt hopeless and helpless, and I noticed there was still a stigma around mental health in the military community, which made it even harder to ask for help.” (Mental Health Session participant)

Following the JP-5 spills, families sought mental health support through therapy and joining advocacy groups:

• “I finally sought counseling, even though the waitlist was long. Once I got in, therapy helped me manage the rage and depression I had from everything that happened. I am still angry, but at least I am not consumed by it.” (Mental Health Session participant)
• “Getting involved with the registry has been my way of fighting back. I use my skills as a nurse and as someone affected to make sure others are heard and supported.” (Mental Health Session participant)
• “We joined advocacy groups because it felt like the only way to get recognition for what happened. Speaking out gave us a sense of control when everything else felt out of our hands.” (Public Health and Health Care Services Session participant)

Pediatric Physical Symptoms

Parents emphasized the ways children’s health was affected. They spoke about rashes, asthma flare-ups, migraines, GI upset, and, in a few cases, more complex medical diagnoses such as toxic encephalopathy and rhabdomyolysis. For some families, these symptoms required hospitalization or extended medical follow-up and created ongoing concern about the long-term development of their children:

• “My child began having more frequent migraines, coughing at night, and was eventually diagnosed with asthma. She also developed rashes and hot spots on her legs and feet.” (Pediatric Session participant)
• “My 4-year-old accidentally brushed her teeth with tap water, and after that she developed rashes, gastrointestinal issues, and anxiety that she had not shown before.” (Pediatric Session participant)
• “My daughter was eventually diagnosed with toxic encephalopathy and spent 6 months in a state of delirium where she could not recognize family members or communicate normally.” (Pediatric Session participant)
• “My son was hospitalized for rhabdomyolysis, and the doctors told me it was likely linked to chemical exposure, possibly toluene.” (Pediatric Session participant)
• “I took her [daughter] to the ER. They insisted she had COVID. I assured them that she did not have COVID. They put us in the COVID tent anyway. Tested her for COVID. She did not have COVID. Said she had a urinary tract infection and sent us on our way. She did not have a urinary tract infection. This was just how the contamination was manifesting in her young body.” (Public Health and Health Care Services Session participant)

Pediatric Mental Health Impacts

Families also highlighted the emotional and behavioral impacts on children. Reported experiences included anxiety, fear of household activities such as plugging in appliances, withdrawal from peers, mood instability, depression, and self-harm. Some children were described as struggling with disturbed sleep or periods of delirium. Parents shared that these challenges were especially difficult to navigate and often lacked adequate professional support:

• “My daughter has PTSD [posttraumatic stress disorder], and therapy is helping her little by little. It is slow progress, but it gives us hope.” (Mental Health Session participant)

• “My child started showing depression-like symptoms, withdrawing from friends and activities that she used to love.” (Pediatric Health Session participant)
• “Both of my children became unable to regulate their moods. One of them started harming herself, and now her arms are covered with scars.” (Pediatric Health Session participant)
• “My daughter developed anxiety and was afraid of things like plugging appliances into the wall. She was diagnosed with PTSD and still struggles years later.” (Pediatric Health Session participant)

Experiences with Accessing and Receiving Care

Several individuals described challenges in obtaining testing, specialty care, or timely appointments. Some noted that local clinicians lacked toxicology knowledge, which limited the medical guidance they received. Individuals also shared difficult encounters where their symptoms were dismissed, which compounded their stress. Others spoke about long waitlists for counseling or the need to seek care off island, which added costs and stress:

• “In the early days, we were told that what we were experiencing was psychosomatic, as if our symptoms were just in our heads.” (Mental Health Session participant)
• “Parents begged for clear answers, but many specialists were hesitant to speak openly because they feared retaliation for acknowledging what was happening.” (Mental Health Session participant)
• “When I took my child to the doctor, we were told simply to avoid the water and let her sweat it out. The doctors admitted they had no real toxicology knowledge.” (Pediatric Health Session participant)
• “We could not find clinicians on island who were receptive, so we had to pay out of pocket for a neuropsychiatrist off island.” (Pediatric Health Session participant)
• “When I tried to get counseling, the waitlist lasted more than 16 months before we could see someone.” (Pediatric Health Session participant)
• “He tried to contact feeling like he was in senior leadership somewhat—their footprint was very small there, the organization he was with. But he tried to contact to say something is wrong. I do not feel right or whatever. Completely blown off.” (Mental Health Session participant)

Listening session participants who were civilian family members found it particularly difficult to access military or government-supported services.

Parents described mixed experiences when seeking care for exposure-related concerns for themselves and their children, and some were told to avoid water use but received little further guidance. Others experienced misdiagnoses or were referred to off-island specialists for validation:

• “We were also not receiving any helpful assistance from pediatricians and neurologists during that time. They told us that very directly, we do not know anything about toxicology, we do not know what to help you with, just avoid the water.” (Pediatric Health Session participant)
• “We eventually saw a pediatric gastroenterologist off island who told us the diarrhea might be connected to nerve damage from exposure, something no one here had ever mentioned.” (Pediatric Health Session participant)
• “The pediatrician was very honest and said that she did not know. But [she] was very forthcoming and reached out to the state toxicologist.” (Pediatric Health Session participant)
• “A psychiatrist told me that my fear of the water was just an aversion to running water and not related to toxic exposure, which made me feel completely dismissed.” (Mental Health Session participant)
• “My children were in and out of the hospital. This was a time when my daughter was not diagnosed yet . . . but going into the hospital with delirium. A hospital social worker called me, and I am thinking finally, someone was going to advocate for her and get the proper treatment. She did not do that. She called children’s services on me because my child had been in the hospital too much.” (Pediatric Health Session participant)
• “Again, there were lots of trauma associated with this [incident] for everyone involved, my children, for myself, because this has been completely life-altering. It is disappointing, especially living on island that we are not acknowledged [and] our exposure is not acknowledged.” (Pediatric Health Session participant)

Structural and logistical challenges were highlighted, such as paying rent on affected homes even while displaced, difficulties relocating with pets, and loss of access to specialists as providers rotated out of the community. These barriers contributed to a sense of disruption and made it harder for some families to fully recover:

• “The cost of traveling off island for appointments was overwhelming, and many of the specialists here rotated out, so there was no continuity of care.” (Pediatric Health Session participant)

• “It was difficult to relocate with pets, and some families felt trapped in unsafe homes because there were no options for boarding or hotels that would take animals.” (Pediatric Health Session participant)

Mental Health Care

Participants consistently noted limited mental health resources, with long waitlists or unavailable services. Some described being told their conditions were psychosomatic or unrelated to water exposure, which left them feeling unsupported. Others shared that stigma in military or medical communities discouraged them from seeking care. Families emphasized the importance of trauma-informed approaches to address both immediate and long-term needs:

• “No mental health resources were offered to us, even a year later at the Red Hill clinic.” (Mental Health Session participant)
• “It was advertised that there were counselors available by what was called the Military Family Support Center. I was so happy to hear that, so I went. . . . They said we will put you on a waiting list; you should call Military OneSource. They said we will try to find someone on island for you to talk to, and that took weeks. Fast forward, and I have spoken to 10 different providers in the span of these years.” (Mental Health Session participant)

Suggested Solutions and Resolutions

Participants offered ideas for moving forward. Suggested measures included developing exposure- and trauma-informed care models, and using presumptive medicine when histories indicate likely exposure. Families also highlighted the need for independent testing laboratories, so that monitoring would be trusted, and called for consideration of disaster-level responses (such as FEMA in similar situations). Many emphasized that acknowledgment, apology, and visible investment in community health would be meaningful steps toward rebuilding trust:

• “To get some providers that would understand the history of this and then be taught that it is okay to practice in some presumptive medicine, and not be afraid to do that to help us, I think would go a long way.” (Mental Health Session participant)
• “Resources such as the neuropsychiatrist and brain mapping and testing like that would have gone a long way in the very beginning and could have helped a lot of people avoid a lot of trauma.” (Mental Health Session participant)

• “A disaster-level response similar to FEMA should have been triggered. That type of structure would have provided consistent support and removed the burden from families to act as their own advocates.” (Mental Health Session participant)
• “We deserve a deep apology and not just us—what they have done to Hawaii.” (Mental Health Session participant)

SUMMARY OF O‘AHU TOWN HALLS

Experiences of Public Health Response

Participants reflected on how different agencies and institutions responded to the releases, noting both strengths and challenges. A recurring theme was the importance of clear and timely communication. Individuals described first learning about water contamination through neighbors, social media, or news outlets rather than directly from authorities. Some said that official messaging changed over time, which contributed to confusion and uncertainty. For example, flushing campaigns and advisories were described as difficult to interpret, and some felt guidance was confusing or inconsistent between agencies.

Another theme discussed was access to services. Individuals noted that water testing on island was initially limited, and that affected communities had difficulty accessing the Red Hill Clinic due to its eligibility rules and limited hours. Those who spoke from the perspective of a civilian family with an active military family member also described barriers to accessing specialized care. Reported barriers to access included eligibility restrictions for civilians, challenges in obtaining specialty referrals, and the financial burdens of relocation. At a broader level, some groups voiced concerns about accountability, pointing to frequent turnover in response leadership and a sense that acknowledgment or apology by responsible parties was lacking.

Incident Communication and Awareness

Participants often learned about contamination through neighbors, social media, or the news, rather than directly from authorities. They described delays, shifting narratives, and missed opportunities for clear communication:

• “Most of them found out about our efforts through Facebook groups.” (Group 3, Afternoon Session participant)
• “Town halls flipped the narrative overnight. . . . Suddenly they admitted they knew and shut the water down earlier.” (Group 1, Evening Session participant)

• “There were delays and mixed messages . . . samples ‘damaged in transit,’ then advisories changed.” (Group 4, Afternoon Session participant)

Access to Health Care Services

Access to services was described as inconsistent. Residents reported limited availability of testing, difficulty accessing clinics, and a lack of clear medical pathways for evaluation:

• “I tried to get into the Red Hill Clinic multiple times. They said, ‘Do you have a DoD [Department of Defense] number? No?’ They would not take [you].” (Group 2, Evening Session participant)
• “Providers had no test to order; HDOH memo said supportive/symptomatic care.” (Group 4, Afternoon Session participant)
• “Red Hill Clinic narrowed hours to 4 hours/week; many couldn’t get in.” (Group 4, Evening Session participant)

Perceptions of Response Effectiveness and Coordination

Participants noted confusion with flushing efforts, advisories, and differences in responding to military family needs compared with civilian needs, which raised concerns that risks were not fully addressed:

• “The guidance told us it was safe to shower if you couldn’t smell fuel, but the chlorine they used masked the smell. That was a huge problem because people thought the water was fine when it really wasn’t.” (Group 1, Evening Session participant)
• “The military was delivering cases of water for us to pick up, and they would have the vat for us to fill up over by the community center. It was a scary time, and my military family friends were put up in hotels in Waikiki. Well, what about us [civilians]? We still [have] to sit in it?” (Group 2, Evening Session participant)
• “They were just opening the fire hydrants, letting the water flush out, and kids were out there doing flips into this pool of flushed water. No one told them to stop, no warnings at all. It was shocking to see because we already knew the water was contaminated, and yet children were literally playing in it.” (Group 3, Afternoon Session participant)
• “People had to decide if flushing was enough to ever make the water safe. Some tried it, others refused. There was no clear answer given, which made the whole thing even more stressful.” (Group 7, Afternoon Session participant)

The Army was often described as mobilizing faster and more comprehensively than the Navy, particularly in relocating families and providing support services:

• “The Army came in and took all the Army personnel and put them in hotels almost immediately. That happened right away, while the Navy kept denying anything was wrong.” (Group 1, Afternoon Session participant)
• “The Army had bus routes, laundry services, and hotels organized very quickly. The Navy dragged its feet, and that difference created a lot of anger because families saw the contrast so clearly.” (Group 1, Evening Session participant)
• “The Army came in fast and set up everything: hotels, laundry service, even bus routes to schools for displaced kids. Meanwhile, Navy families were told to sit tight and wait. The difference in response was night and day, and it created even more distrust.” (Group 3, Evening Session participant)

Barriers to Care

Structural barriers made care difficult to obtain. These included eligibility restrictions, specialty care shortages, and the financial burden of paying rent while displaced:

• “During those first weeks, everything felt chaotic. People were desperate for medical care, but only military families were allowed into Tripler or the base clinic. If you weren’t military, you couldn’t get on the base to get to the clinic. That meant local families had no access to the services even though they were just as affected, and they were left scrambling to find civilian providers who didn’t know what to do either.” (Group 1, Afternoon Session participant)
• “For a while, we thought maybe things would improve if we could just get in to see the right specialists. But then neurology access was lost as specialists PCSed [permanent change of station] or retired, and referrals became impossible. Families with ongoing neurological issues had nowhere to turn, and the few doctors still here had waitlists that stretched for months. That left people feeling abandoned right when they needed continuity of care the most.” (Group 1, Evening Session participant)
• “Families displaced to hotels still had to keep paying rent on their poisoned homes, which left them financially strapped and feeling trapped. It felt like insult on top of injury, because you couldn’t live safely in your house, but you still had to pay for it and then

• cover all the extra expenses of displacement.” (Group 7, Afternoon Session participant)
• “The communication wasn’t the greatest, especially for physicians outside of the DoD or VA [Department of Veterans Affairs] system.” (Group 4, Afternoon Session participant)

Reflections on Accountability and Response Policies

Residents and providers often reflected on broader accountability issues. Concerns included leadership turnover, lack of continuity, and a sense that acknowledgment or apology was missing:

• “The lawsuit we were in was such a disappointment. The Navy was found guilty on all three counts, but the amount of money [fined] was not even a million dollars. It was just a slap on the wrist [for the Navy].” (Group 1, Afternoon Session participant)
• “There’s this history—not just one spill, not just one incident, but a whole larger system of spills and cover-ups. People here know that Red Hill is just the latest chapter in a much longer story.” (Group 7, Afternoon Session participant)
• “Commanders rotate every 3 years, so there’s no continuity. Nobody stays long enough to really be held accountable. And still, after everything, there’s been no acknowledgment and no real apology.” (Group 4, Afternoon Session participant)
• “What broke me was that the Navy flipped its story overnight in those town halls. On Monday, they were saying one thing, and by Thursday they admitted something completely different—but without ever admitting fault. That’s when I realized we had been lied to.” (Group 1, Evening Session participant)

Discussions on Health Impacts and Experiences

Across discussion groups, town hall participants frequently described heightened perceptions of risk related to drinking, cooking with, or bathing in tap water following the Red Hill fuel releases. Many recalled learning about potential concerns through informal channels such as social media, neighbors, or the news, rather than through direct official outreach. Some felt that this contributed to uncertainty and confusion, and eroded trust in particular response actors. For example, while the Navy was often viewed with skepticism, the Army was sometimes perceived as more forthcoming in its communication.

Discussion participants also reflected on how delays in communication, changes in messaging, and limited coordination across agencies contributed to

reduced confidence in the overall response. Individuals raised concerns about disparate response actions and potential health impacts. For example, military personnel and families living on base were noted to have been prioritized for rehousing, whereas vulnerable groups, including housing renters, families in low-income housing, those with pets, and prisoners, were not prioritized.

Perceived Risk

Participants described ongoing concern and caution when using water, even years after the incident. Individuals reported avoiding drinking, cooking, or even cleaning with tap water, reflecting a persistent sense of risk, based on both lived experiences of symptoms and broader concerns about whether remediation could restore trust in the water supply:

• “Patients told me, ‘I stopped drinking the water and I got better.’” (Group 4, Afternoon Session participant)
• “Knowing that you’re drinking tap water, but not knowing [if] it’s affected.” (Group 1, Evening Session participant)
• “We don’t drink the water. We don’t cook with the water. . . . We’re afraid of it.” (Group 1, Afternoon Session participant)
• “People . . . still don’t trust or feel safe drinking their tap water, or they’ll still always buy bottled water.” (Group 7, Afternoon Session participant)
• “Some . . . don’t even feel comfortable cleaning the house with tap water.” (Group 7, Afternoon Session participant)

Adult Physical Health Impacts and Experiences

Adults reported a range of symptoms. Acute effects included rashes, GI distress, migraines, dizziness, and eye irritation, which were attributed to contaminated water use. Chronic concerns included ongoing neurological and reproductive problems, as well as fears about cancer recurrence or precancerous findings.

Quotes on acute symptoms:

• “Waking up with really bad heartburn, severe stomach pain, diarrhea . . . woke up super bloated” (Group 1, Evening Session participant)
• “I told her that all of us are experiencing migraines, rashes, [and] our asthma was increased. The two of us who have asthma—with both people, it was escalated.” (Group 1, Evening Session participant)

• “Patients presented with eye irritation, upset stomach, dizziness, brain fog.” (Group 4, Afternoon Session participant)

Quotes on chronic concerns:

• “My husband’s a 10-year cancer survivor . . . [who] worries it’s coming back from the water.” (Group 1, Afternoon Session participant)
• “Still dealing with neurological, dermatological, or reproductive concerns.” (Group 7, Afternoon Session participant)
• “Persistent stomach pain led to precancerous polyp removal.” (Group 1, Evening Session participant)

Adult Mental Health Impacts

Adults described high levels of stress and anxiety, often triggered when new information surfaced. Some participants expressed hopelessness, saying they felt nothing was improving. Coping strategies varied among participants and included seeking community water distributions or mutual aid, therapy, and engaging in advocacy efforts.

Quotes on stress, anxiety, and trauma:

• “Been to these meetings, month after month after month, and every time it just brings it all back up again . . . the frustration, the anxiety.” (Group 1, Afternoon Session participant)
• “It enormously added to people’s stress.” (Group 3, Afternoon Session participant)
• “What happened with the Navy broke something, because that’s my country. That’s who fights for me, and suddenly I have this deep sense of distrust for somebody who I’ve always respected, looked up to, and honored. I also had a husband who served in the military, and the feeling of distrust was very psychologically confusing to me because with a human you lose trust and that’s the end of the story. But with something that is an entity as large as [the Navy], do I trust you to defend my rights in times of war or am I going to have to do it myself?” (Group 1, Evening Session participant)
• “I was angry, depressed . . . families [were] poisoned and gaslit.” (Group 4, Evening Session participant)
• “This was Chernobyl for O‘ahu.” (Group 7, Evening Session participant)
• “We went from COVID to this pretty back-to-back, and it was pretty traumatic and had this very surreal feel for a really long

• time. Then just as more information kept coming out, every time there was like a news article, it was like a punch in the guts, and there was fear and anxiety searching for every piece of research that you could find. It was just a continuing rabbit hole of reading research articles and trying to piece these things together and then just rage.” (Group 1, Evening Session participant)

Quotes on depression and hopelessness:

• “It feels like nothing’s getting done; nothing makes a difference.” (Group 4, Afternoon Session participant)
• “Such a failure. . . . I’d be ashamed for them.” (Group 7, Afternoon Session participant)
• “Compensation was insulting . . . our suffering reduced to a dollar amount.” (Group 7, Evening Session participant)

Quotes on coping strategies and alternative care:

• “We had a group that would be in the community on a Saturday once a month and give out water.” (Group 1, Afternoon Session participant)
• “My way of protesting was seeking information, joining studies, registry work.” (Group 1, Evening Session participant)
• “Detoxing, supplements, saunas, hyperbaric therapy.” (Group 4, Evening Session participant)

Pediatric Health Impacts and Experiences

Parents described concerns for their children’s health, including school-related disruptions (e.g., reliance on bottled water, use of outdoor handwashing stations, avoidance of tap water during meals). Children also experienced acute and chronic physical effects, including emergency department visits, rashes, asthma, and blisters. In addition to physical symptoms, participants shared accounts of the psychological impacts on their children, such as diagnoses of PTSD, self-harm behaviors, debilitating anxiety, violent outbursts, disturbed sleep, and delirium. Parents reflected on the trauma of watching their children struggle emotionally without adequate support.

Quotes on school-related disruptions:

• “We tried to provide water for the elementary school. . . . Kids had to bring bottles.” (Group 1, Afternoon Session participant)

• “One school told kids not to wash their hands [and] set up water containers.” (Group 7, Afternoon Session participant)
• “They [families] told the kids they couldn’t drink the water or use the water.” (Group 1, Afternoon Session participant)

Quotes on acute and chronic health impacts:

• “Children were taken to the ER over 700 times.” (Group 1, Afternoon Session participant)
• “Kids [were] seen playing in flushed hydrant water.” (Group 3, Afternoon Session participant)
• “Every time they bathed their kid, they would scream.” (Group 4, Afternoon Session participant)
• “One of the things that was coming up a lot in the Pearl City Peninsula, that’s a housing area, was that they [families] were throwing up in the showers. I kept hearing that and when I talked to a toxin expert he said imagine heating up fuel and then being stuck breathing it in a closed space, that probably explains why they’re getting sick in the showers.” (Group 7, Evening Session participant)
• “It’s also about the kids and the pets that are running around in the grass, because when the pipes are flushed, they flush the pipes in the yards, not into the street, but into the yards. So you’ve got toxic soil potentially, and I don’t know the chemical life cycle, but I do know that there’s that possibility from other hazmat issues that are out there.” (Group 7, Evening Session participant)

Quotes on pediatric mental health impacts:

• “My daughter has been diagnosed with PTSD from the water.” (Group 1, Afternoon Session participant)
• “My one daughter . . . went from difficulty walking to depression and self-harm. Her arms are all scarred up. This is like a 9-, 10-year-old. Debilitating anxiety . . . she couldn’t get out of bed for days to go to school. One of the times her twin sister was also struggling with the same symptoms, depression, only hers she was violent, with other people in the house, threatening her dogs, was raging, and crying all the time.” (Group 4, Evening Session participant)

Experiences Receiving or Giving Health Care Following the JP-5 Releases at Red Hill

Insights shared by individuals who sought health care, as well as those providing health care following the JP-5 releases, highlighted gaps between

individual provider capacities, health care delivery system capacities, and health needs of affected individuals. Town hall participants described limited clinical availability, clinic access, and specialist staffing, as well as limited guidance on testing and care. These factors contributed to affected individuals feeling that their concerns and needs were being dismissed by care providers.

• “I’ve gone to many physicians . . . most of them just stare at you like a deer in the headlights.” (Group 1, Afternoon Session participant)
• “People are going to doctors and doctors are like, ‘I don’t know what to do with this.” (Group 1, Afternoon Session participant)
• “Providers had no validated ‘JP-5 [jet propellant-5] test’; HDOH guidance emphasized supportive care.” (Group 7, Afternoon Session participant)
• “PCMs [primary care managers] annotated exposure but offered no treatment . . . [said] ‘stop drinking water, symptoms will pass.’” (Group 1, Evening Session participant)
• “Doctors [were] told ‘don’t test, don’t treat.’” (Group 4, Evening Session participant)
• “PTSD is a real thing. None of that’s [care] been provided. You just quit trying or you go to civilian [doctors] or you pay out of pocket.” (Group 1, Afternoon Session participant)
• “Therapy helped manage rage and PTSD . . . but stigma and leadership dismissals worsened shame.” (Group 1, Evening Session participant)

Suggestions for Addressing Health Care Needs

Participants offered suggestions for addressing continued health care needs of affected communities including through exposure- and trauma-informed care, independent laboratories, expanded clinic access, and inclusion of prison and pet populations in health monitoring, as well as long-term health monitoring through independent registries and International Classification of Diseases (ICD) code–based health impact tracking. Additional suggestions to better support the affected community included replacement of household water systems, access to water filters, and compensation for incurred expenses. Discussions also highlighted opportunities to improve communications and response efforts, such as through multilingual outreach, proactive door-to-door communication, and consideration of how disaster declarations may improve responses to similar contamination incidents. Multiple discussion groups also emphasized the importance

of acknowledgment and apology from federal authorities. The acts of acknowledgment and apology were described as

• a necessary first step for reconciliation;
• a condition for meaningful healing alongside compensation and care; and
• something that has been withheld to date, leaving communities feeling dismissed and dishonored.

Quotes on improving care:

• “Doctors need to understand . . . being exposure informed.” (Group 1, Evening Session participant)
• “We cannot just cut us off here and not address the mental health aspect . . . this requires trauma-informed care.” (Group 4, Evening Session participant)
• “I sat through most of the federal trial this summer, and their only argument was that we were all psychosomatic.” (Group 4, Evening Session participant)
• “Stand up an independent registry and coordinated expert team quickly . . . don’t take years.” (Group 4, Afternoon Session participant)
• “We need an EPA [U.S. Environmental Protection Agency]–certified lab here in Hawai‘i . . . not just equipment, but sustainable funding.” (Group 3, Afternoon Session participant)
• “We need an independent lab. The only people testing are the Navy, and people won’t trust the ones who sickened them.” (Group 4, Evening Session participant)
• “I would love to see ICD-10 codes around this, so providers can chart exposure confidently. If we had ICD codes and presumptive medicine, doctors would be less afraid to chart our history.” (Group 4, Evening Session participant)
• “Track pets and prisons too . . . service animals and inmates were impacted.” (Group 1, Afternoon Session participant)
• “Whether or not there’s a monetary compensation for their [the Navy] care and damage, a long-term health initiative that takes care of families who might have been affected, that the Navy provides. There are many options, but I don’t know if there’s any one silver bullet that’s going to restore that trust that people once had. I once lived on that housing long ago and you trust it, you think, okay, well, I’m sure they’re taking care of the water, I’m sure it’s all good. . . . Once that major withdrawal from that trust bank

• is made, it’s tough to get it back.” (Group 3, Afternoon Session participant)

Quotes on improving communication and community protections:

• “Private management refused to replace water heaters. . . . Independent testing is the only way we’ll believe results.” (Group 4, Evening Session participant)
• “Every house needs water filters.” (Group 4, Evening Session participant)
• “Go door to door in impacted neighborhoods. . . . Don’t rely on websites.” (Group 4, Evening Session participant)
• “Ensure multilingual communication . . . Tagalog, Ilocano, Chuukese, Spanish.” (Group 7, Evening Session participant)

Quotes on response reforms, accountability, and apology:

• “This should have been declared a national disaster, like Flint, like Katrina, so FEMA would have been on the ground.” (Group 4, Evening Session participant)
• “Just an acknowledgment or apology from the Navy to acknowledge what they did, and that there’s continuing health issues.” (Group 1, Afternoon Session participant)
• “A real apology that acknowledges and takes full responsibility. They’ve never done that. They don’t acknowledge that they’ve done anything wrong.” (Group 4, Evening Session participant)
• “Apology. A real apology. The Navy has never done that, ever.” (Group 4, Evening Session participant)
• “We need counseling and recognition. . . . Reconciliation requires admitting wrongdoing.” (Group 7, Afternoon Session participant)
• “Honestly, a heartfelt apology to the people. . . . That would be a start.” (Group 7, Evening Session participant)
• “Our pipes need to be replaced, but they’re not being replaced.” (Group 7, Evening Session participant)

OVERVIEW OF THEMES ACROSS VIRTUAL AND COMMUNITY ENGAGEMENT LISTENING SESSIONS

Adult Health Impacts

Across transcripts, adults described persistent stress, anxiety, depression, and trauma connected to the water contamination and its aftermath. Some shared experiences of postpartum depression or worsening preexisting

conditions, while others spoke about trauma triggered by caring for ill children or being dismissed by providers. A strong theme was the sense of betrayal when symptoms were minimized or attributed to psychosomatic causes. Feelings of helplessness, hopelessness, and being stigmatized within military communities compounded these challenges. Still, participants identified coping strategies—such as therapy, peer support, community water distributions, and advocacy—which provided resilience and restored some sense of agency.

Pediatric Health Impacts

Parents consistently reported health problems among children, ranging from rashes, asthma, migraines, and GI issues to more serious cases such as encephalopathy and rhabdomyolysis. In several instances, children required hospitalization or ongoing specialty care. Even seemingly minor exposures, such as brushing teeth with tap water, were associated with adverse reactions. These accounts underscored the heightened vulnerability of children and the deep concern parents felt about potential long-term impacts. Families linked pediatric symptoms with both immediate disruptions to daily life and sustained worries about developmental health.

Communication and Awareness

Families frequently pointed to communication challenges as one of the most distressing parts of the response. Many said they first learned about the crisis from neighbors, Facebook groups, or local media rather than through direct official notification. Early messages were described as dismissive or inconsistent, with some residents being told their symptoms were “in their heads.” Over time, shifting explanations and delays in acknowledging contamination eroded trust. Participants expressed that clear, timely, and consistent information could have prevented confusion, eased fears, and strengthened public confidence.

Access to Health Care Services

Participants described difficulties in accessing appropriate medical and mental health care. Toxicology expertise was limited on the island, and many providers admitted they did not know what to do beyond recommending “avoid the water.” Families sometimes traveled off island at personal expense to see specialists who were more receptive. Counseling and psychiatric support were constrained by long waitlists and frequent provider turnover. Civilian families also faced barriers in accessing military or federally supported clinics. Overall, participants conveyed that services felt

fragmented, slow to mobilize, and often inaccessible at the time they were most needed.

Response Policies and Accountability

Concerns about responsibility and acknowledgment surfaced repeatedly across transcripts. Participants noted leadership turnover, delayed recognition of contamination, and explanations that sometimes changed without acknowledgment of earlier mistakes. For some, this created a sense that no one was fully accountable for what had happened. Families expressed that a formal apology or acknowledgment of harm would be meaningful steps in rebuilding trust. Broader reflections connected individual experiences to a larger history of spills, highlighting the need for sustained accountability mechanisms rather than temporary fixes.