Most people who were affected by the November 2021 Red Hill fuel spill continued to experience physical, emotional, social and/or financial impacts more than 20 months after the incident, according to a new report released October 15, 2025, by the University of Hawaiʻi Economic Research Organization (UHERO).
The report provides results from a follow-up self-administered online survey conducted in July 2023 (20 months after the spill) with 174 people who had participated in earlier studies by the Centers for Disease Control and Prevention.
Main findings reported in 2023
Ongoing physical and mental health impacts:
- About three quarters (79%) of respondents reported one or more new or worsening physical and/or mental health symptoms since the 2021 fuel spill.
- A majority (68%) reported ongoing symptoms in 2023, nearly two years after the spill.
- Nearly half of respondents (49%) continued to suffer from mental health impacts, followed by neurological symptoms (44%), gastrointestinal issues (36%) and skin/eye symptoms (34%).
Healthcare response:
- The majority (65%) of respondents sought medical care related to the spill.
- Experiences with medical care were mixed: 24% of respondents rated the medical care they received for their exposure to the fuel spill as excellent or good whereas 36% rated their care as bad or very bad.
- More than 50% of respondents said they have a great deal of trust in their healthcare provider to provide correct information; less than 5% said they have no trust.
- The vast majority of open-ended responses about healthcare described dismissed concerns, insufficient documentation of symptoms, inadequate testing options and challenges accessing specialists.
Social and economic impacts:
- Many reported feelings of isolation as a result of health impacts and disaster response.
- Some respondents also pointed to ways that the community organized and supported one another in disaster response.
- Some (18%) reported income loss (median = $13,750 annual income), while the majority (82%) incurred additional out-of-pocket expenses (median = $8,200).
- Only 12% of those with out-of-pocket expenses said they were fully reimbursed, and more than a third (36%) said they received nothing at all.
Institutional trust and perceptions of institutional crisis response:
- Respondents were most satisfied with how the Honolulu Board of Water Supply responded to the crisis and least satisfied with the response of the Navy.
- Many expressed feelings of betrayal, particularly toward the Navy. Many respondents said they felt lied to about the safety of the water, and cited inadequate medical and other crisis response as factors undermining trust.
- Participants discussed a need for greater transparency, accountability and empathy in future crisis response.
"Findings reveal significant and ongoing well-being impacts including physical and mental health challenges, disruptions to social networks and relationships and financial losses," the study wrote.
The report was authored by experts from UHERO, Water Resources Research Center , Institute for Sustainability and Resilience , Department of Geography and Environment , Department of Economics and Red Hill Registry , all at UH.
Read the entire report on UHERO's website .
UHERO is housed in UH Mānoa's College of Social Sciences .
The post Lingering pain, lost trust: Study reveals ongoing effects from 2021 Red Hill spill first appeared on University of Hawaiʻi System News .
