Marshall Islands

The Marshall Islands are located in the Pacific Ocean, north of Nauru and Kiribati. The republic is comprised of 29 atolls forming two parallel groups known as the Ratak and Ralik (or “Sunrise” and “Sunset”) Chains. Ten of the 29 atolls are uninhabited, and the total landmass of all the islands are 181.3 km2, or about the size of Washington DC. The Marshalls were colonized by Germany in the 1880s, and fell to Japan after World War I. In 1947, they became a United States Trusteeship, although they remained largely self-governing. The trusteeship finally ended in 1990, and the Republic of the Marshall Islands was admitted to the United Nations in 1991. It maintains close economic and diplomatic ties with the U.S.

The population is 61,800 and growing at 2.21 percent annually. The birth rate is 32.37 per 1,000, compared with a death rate of just 4.66 per 1,000. This more than compensates for the negative migration rate of minus 5.65 per 1,000. Median age is 20.7 years. Life expectancy is 68.61 years for males and 72.71 years for females.

Gross national income is $2,930 per capita. Island economy is dependent on U.S. aid and remittances from Marshallese living abroad, with most islanders relying on subsistence farming and fishing and a small tourism industry.

Common, generally non-fatal communicable diseases are the main causes of hospital admissions in the Marshall Islands. The Ministry of Health lists influenza, gastroenteritis, scabies, diarrhea, fish poisoning, chicken pox, conjunctivitis, syphilis and amoebas as the leading causes of morbidity. Hepatitis A and B, along with typhoid, are also common. There were 62 cases of leprosy diagnosed in 2004. There were also 119 new cases of tuberculosis. Like many of the Pacific Islands, AIDS has not emerged as a problem.

As Marshallese live a more “modern” life, they are quickly absorbing the negative health aspects of that modernity: obesity, increases rates of tobacco, drugs, and alcohol use, more traffic accident, increased suicide rates, and a higher rate of teen pregnancy rates have all been noted by medical authorities. The leading cause of mortality is sepsis, followed by cancers, heart disease, pneumonia, suicide, renal failure, drownding, and trauma.

Between 1946 and 1962, the United States conducted a number of weapons tests on the isolated atolls outside the Marshall Islands, the most notable of which was the March 1954 detonation of a hydrogen bomb on Bikini Atoll. The fallout was supposed to blow harmlessly out to sea, but a shift in the winds dropped in directly onto the Tongelap and Utrik atolls of the Marshalls.

Over the years, residents have complained of increased rates of stillbirths, malformed or “jelly babies,” strange cancers, goiters, and stunted growth among children, even decades after the fact. A Nuclear Claims Tribunal wrapped up hearings in 2004, but resulted in few provisions for longterm testing or monitoring of the health of these communities.

The Ministry of Health had a $16 million budget in 2004. There is one general hospital, one primary-care hospital, and five health centers on the islands. Medical staff numbers 547, with 32 physicians, 193 nurses, and 6 dentists. Among the 32 doctors, 25 are non-Marshal-lese; [Page 1071]all the dentists are also expatriates. For nurses, 44 are expatriates, and 149 are Marshallese.

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